Sir,

Endogenous endophthalmitis is intraocular infection resulting from haematogenous spread from a remote source. We report a case of endophthalmitis caused by Sporobolomyces salmonicolor in a reasonably healthy woman. To the best of our knowledge, S. salmonicolor endophthalmitis has not been previously reported.

Case report

A 31-year-old lady presented with a 3-day history of decreased vision in the left eye. She had been treated 2 years previously for pelvic inflammatory disease. Her visual acuity was 6/4 in the right eye and 6/18 in the left. The right eye was normal. The left eye showed fibrinous exudates in anterior chamber, posterior synechiae, and vitritis. She was commenced on oral prednisolone and intensive topical steroids, and a cycloplegic. FBC, ACE levels, anti-Toxoplasma Ab titre, Lupus anticoagulant, ANCA, and X-rays of the chest and sacro-iliac spine were reported normal. With little improvement over 2 weeks, vitreous biopsy and intravitreal injection of amikacin 400 μg, vancomycin 1 mg, amphoterecin 5 μg, and dexamethasone 400 μg was performed. Vitreous sample showed pink colored yeast-like organism, possibly Rhodoturela. She was started on Tab. fluconazole 200 mg twice a day. Vitreous sample was sent to a tertiary microbiology department where the yeast was identified as S. salmonicolor. Sensitivity recommended the use of voriconazole 200 mg twice a day which was continued for 2 months. Improvement was seen within a week. Six months from presentation, the vitreous cavity remains clear on no antifungals with a final visual acuity of 6/12.

Comment

Risk factors for endogenous fungal infections include bacterial sepsis, corticosteroid therapy, immunosuppression, intravenous drug abuse, malignancy, alcoholism, and haemodialysis.

Sporobolomyces, a yeast closely related to Rhodoturela, is commonly isolated from environmental sources, such as air, tree leaves, and orange peels. The natural habitats are humans, mammals, birds, the environment, and plants. Infections that have so far been reported due to Sporobolomyces are lymphadenitis,1 dermatitis,2 cerebral infection, and fungemia.3 Although Rhodotorula-related endophthalmitis has been reported,4, 5, 6, 7 ophthalmic infection caused by Sporobolomyces has not been previously reported.

Our patient had no obvious predisposing risk factors except for previous pelvic inflammatory disease which may have been a source. The low level of suspicion led to the use of systemic steroids prior to the use of systemic antifungal therapy and this may have contributed to the slightly prolonged course. It is therefore important to maintain a high level of suspicion and attempt to identify any possible infective pathogen in cases with unusual presentation.