Candidal endophthalmitis in a renal transplant patient
(Section Editor: G. H. Neild)
Robert Dedi1,,
Ajay Kumar1,
Bernard Chang2,
Mark J. Wright1 and
Aleck M. Brownjohn1
1 Departments of Renal Medicine
2 Ophthalmology, The General Infirmary at Leeds, Leeds, UK
Keywords: candidal endophthalmitis; immunosuppression; panophthalmitis; synechiae; uveitis
A 70-year-old woman underwent renal cadaveric transplantation with urinary diversion into an ileal conduit. Standard immunosuppression with cyclosporin, azathioprine and prednisolone was used. One month later she presented with a painful, red left eye. Visual acuity in this eye had deteriorated to hand movements only. Ophthalmological assessment revealed a panophthalmitis with ciliary injection, posterior synechiae, and anterior uveitis (Fig 1
). Fundal examination revealed retinitis (Fig 2
) with no evidence of retinal detachment. Minute fungal puff balls were seen in the periphery of the posterior vitreous. Blood cultures and vulvo-vaginal swabs were sterile, but urine culture grew Candida sp. on several occasions. A diagnosis of candidal endophthalmitis was made and treated with liposomal amphotericin given intravenously for 2 weeks, followed by oral fluconazole. Although the external appearance of the left eye resolved, visual acuity continued to deteriorate, and progressed to light perception only.

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Fig. 1. Anterior segment photomicrograph showing ciliary injection, posterior synechiae, and uveitic cataract.
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Candidal endophthalmitis is the most common form of non-traumatic endophthalmitis, with a characteristic ocular appearance [1]. It represents haematogenous spread from a distant source of infection, and the risk of intraocular infection is significant in immunosuppressed patients with candidaemia [2]. There is no consensus on the optimal management, but intravenous and intravitreal amphotericin, oral fluconazole, and vitrectomy have all been advocated [3]. Approximately 25% of cases may suffer permanent significant visual impairment [4], although early empirical therapy following a presumptive diagnosis based on the clinical signs favourably influences the course of the disease [5].
Notes
Correspondence and offprint requests to: Dr R. Dedi, Department of Renal Medicine, The General Infirmary at Leeds, Welcome Wing, Great George Street, Leeds LS1 3EX, UK. 
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