Candida endogenous endophthalmitis as a cause of initially presumed intermediate uveitis in a psoriatic patient with long-term immunosuppressive treatment.
Purpose
To report a case of endogenous candida endophthalmitis that was initially presented as intermediate uveitis
Methods
Case report
Results
A 52-year-old woman presented with a unilateral blurry vision on the right eye gradually worsened within 5 months. She had a history of Sjogren syndrome and psoriasis treated with prednisolone 5 mg/day and tacrolimus 0.5 mg/day since 7 years ago. Visual acuity was hand movement with cells and a large snowball in the middle of the anterior vitreous on the right eye. The work-up was unremarkable except for a reactive toxoplasmosis IgG and a positive IGRA. Due to the unresponsiveness to the standard toxoplasmosis, we did a vitrectomy, and Candida albicans grew from the vitreous culture. The PCR for toxoplasma and Mycobacterium tuberculosis from the vitreous and serology Toxocara test from the blood were negative. We decided to give Amphotericin B intravitreal injection and Voriconazole intravenous injection 200mg bid for two weeks. HD-OCT showed a new cystoid macular lesion and increased in size in 3 days, responding to sub-tenon Triamcinolone Acetonide injection.
Conclusion
In long-term immunosuppressive treatment patients, we should consider candida as the possible etiology of intermediate uveitis. Early vitrectomy and antifungal treatment are essential. Cystoid macular edema is effectively controlled with periocular steroid injection.
Conflict of interest
No
Authors 1
Last name
KURNIAWARDHANI
Initials of first name(s)
Dew
Department
Department of Ophthalmology, Cipto Mangunkusumo Hospital
City
Jakarta
Country
Indonesia
Authors 2
Last name
Djatikusumo
Initials of first name(s)
Ari
Department
Department of Ophthalmology, Cipto Mangunkusumo Hospital
City
Jakarta
Country
Indonesia
Authors 3
Last name
Nora
Initials of first name(s)
RLD
Department
Department of Ophthalmology, Cipto Mangunkusumo Hospital
City
Jakarta
Country
Indonesia
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