TITLE:
Postoperative Endophthalmitis Caused by Candida Parapsilosis: A Case Report
AUTHORS:
María del Pilar Lucena, Federico Furno Sola, Mitzy E. Torres Soriano, Fanny Andrea Gerster
KEYWORDS:
Endophthalmitis, Candida, Cataract Surgery, Nail Infection
JOURNAL NAME:
Open Journal of Ophthalmology,
Vol.9 No.2,
April
15,
2019
ABSTRACT: Purpose: To report an unusual case of postcataract
endophthalmitis secondary to Candida parapsilosis. Case Presentation: A
77-year-old female patient was admitted to the emergency ward with reduced
visual acuity (VA), and redness and pain
in the right eye (RE) with a few hours of evolution. The patient underwent
cataract surgery in the right eye 50 days earlier; no abnormalities were
discovered in postsurgery check-ups on the following days. Biomicroscopy revealed corneal oedema, tyndall ++++, and flare +++. Capsule-shaped
whitish deposits and posterior synechiae were also reported. Fundoscopy: not
visible due to anterior segment opacity. RE ultrasound: mild vitritis, attached retina. Due to a strong suspicion
of endophthalmitis, an aqueous humour biopsy was performed and the
presence of Candida parapsilosis sensitive to amphotericin B
and voriconazole was revealed. In view of a poor prognosis, we decided to carry
out a vitrectomy, removal of the IOL + capsular bag complex and intravitreal
injection of amphotericin B. After several check-ups, the patient reported
being diagnosed with a fungal infection in her fingernails some time ago. She
was referred for a microbiological testing,
which confirmed the presence of Candida in the fingernails. Conclusions: Fungal endophthalmitis is uncommon in
the postoperative setting, with most of the cases being attributable to the Candida species. The combination of pars plana vitrectomy, removal of the IOL + capsular bag complex and antifungal agents was
able to successfully treat this case of postoperative endophthalmitis due to Candida parapsilosis.
The relationship between postoperative Candida endophthalmitis and Candida nail
infection is dramatic. To date, only one case of endogenous endophthalmitis associated
with complicated onychomycosis has been
reported.