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 1Go). Fundal examination revealed retinitis (Fig 2Go) 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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Fig. 2. Posterior segment photomicrograph showing vitreous opacity and retinitis.

 
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. Back

References

  1. Edwards JE Jr, Foos RY, Montgomerie JZ, Guze LB. Ocular manifestations of Candida septicaemia: review of seventy-six cases of haematogenous Candida endophthalmitis. Medicine1974; 53: 47–75[ISI][Medline]
  2. Donahue SP, Greven CM, Zuravleff JJ et al. Intraocular candidiasis in patients with candidaemia. Clinical implications from a prospective multicenter study. Ophthalmology1994; 101: 1302–1309[ISI][Medline]
  3. Edwards JE Jr, Bodey GP, Bowden RA et al. International Conference for the Development of a Consensus on the Management and Prevention of Severe Candidal Infections. Clin Infect Dis1997; 25: 43–59[ISI][Medline]
  4. Essman TF, Flynn HW Jr, Smiddy WE et al. Treatment outcomes in a ten year study of endogenous fungal endophthalmitis. Ophthalmic Surg Lasers1997; 28: 185–194[ISI][Medline]
  5. Schmid S, Martenet AC, Oelz O. Candida endophthalmitis: clinical presentation, treatment and outcome in 23 patients. Infection1991; 19: 21–24[ISI][Medline]




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