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Misdiagnosed case of fungal endophthalmitis

Eye (2023)Cite this article

Subjects

A 57-year-old diabetic female was referred as a case of recurrent vitritis, which used to respond to topical steroids, after uneventful Left eye cataract surgery. Few exudates (snowballs) with vitreous haze were seen in inferior periphery. She was treated with posterior sub-tenon’s triamcinolone injection. Three months later, there was increased vitreous haze with multiple exudates all over the posterior pole. According to the international committee of Intraocular Inflammation Society recommendation [1], the patient was taken for vitrectomy. Intra-operatively, multiple yellowish colonies were seen all over the posterior pole [Image] which were removed using a flute needle. At the end of surgery, intra-vitreal anti-fungal was injected. A microbiology report showed Aspergillus as a growth. The patient was treated with oral Fluconazole & intra-vitreal Amphotericin B. At 2 months post op, the patient improved to 6/6 vision with quiet vitreous cavity & no evidence of any exudation.

Learning from this case report:

  1. 1.

    In a case of inflammation post-surgery, with snowball like lesions in inferior periphery, always suspect fungal endophthalmitis unless proved otherwise. Treat every case aggressively as fungi are known for its chronicity.

  2. 2.

    Avoid use of steroids in suspected cases of fungal endophthalmitis.

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Reference

  1. Narendran N, Balasubramaniam B, Johnson E, Dick A, Mayer E. Five-year retrospective review of guideline-based management of fungal endophthalmitis. Acta Ophthalmol. 2008;86:525–32. https://doi.org/10.1111/j.1600-0420.2007.01097.x.

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Authors and Affiliations

  1. Consultant Vitreo-retina & ROP Specialist, Sarakshi Netralaya, 19, Rajiv Nagar, Wardha Road, Nagpur, Maharashtra, 440025, India

    Shilpi H. Narnaware

  2. Vitreo-Retinal Surgeon, Sarakshi Netralaya, 19, Rajiv Nagar, Wardha Road, Nagpur, Maharashtra, 440025, India

    Prashant K. Bawankule

  3. OT assistant, Sarakshi Netralaya, 19, Rajiv Nagar, Wardha Road, Nagpur, Maharashtra, 440025, India

    Suraj Sontakke

Authors
  1. Shilpi H. Narnaware
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  2. Prashant K. Bawankule
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  3. Suraj Sontakke
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Corresponding author

Correspondence to Shilpi H. Narnaware.

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Narnaware, S.H., Bawankule, P.K. & Sontakke, S. Misdiagnosed case of fungal endophthalmitis. Eye (2023). https://doi.org/10.1038/s41433-023-02861-w

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  • DOI: https://doi.org/10.1038/s41433-023-02861-w

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