J Korean Ophthalmol Soc.  2008 Oct;49(10):1701-1705.

Endogenous Candida Endophthalmitis with Bilateral Massive Submacular Abscess

• Ku M
• Jung JO
• Lee DY
• Nam DH

Abstract

PURPOSE
We present a case of endogenous endophthalmitis in which the patient presented with an overall clinical picture suggestive of bacterial endophthalmitis but was subsequently found to have Candida endophthalmitis.
CASE SUMMARY
A 50-year-old man with hepatic encephalopathy and alcoholic liver cirrhosis who was treated in gastroenterology presented with reduced vision in both eyes. Indirect ophthalmoscopy showed bilateral massive submacular abscesses and surrounding retinal hemorrhage. In view of the initial fundal picture of a submacular abscess lesion, the subacute course of the disease, and a medical history of diabetes and liver cirrhosis, a provisional diagnosis of bacterial endophthalmitis was made. Treatment with topical and systemic empirical antibiotics was immediately initiated.
CONCLUSIONS
Candida albicans should be considered in the differential diagnosis of endogenous endophthalmitis when massive submacular abscesses and hemorrhage are seen.

Keyword

Endogenous endophthalmitis; Candida endophthalmitis

MeSH Terms

Abscess
Anti-Bacterial Agents
Candida
Candida albicans
Diagnosis, Differential
Endophthalmitis
Eye
Gastroenterology
Hemorrhage
Hepatic Encephalopathy
Humans
Liver Cirrhosis
Liver Cirrhosis, Alcoholic
Middle Aged
Ophthalmoscopy
Retinal Hemorrhage
Vision, Low
Anti-Bacterial Agents

Figure

• 

  Figure 1. Slit lamp photographs show markedly injected conjunctiva, chemosis, and edematous cornea.

• 

  Figure 2. Fundus photographs show bilateral massive yellow-white abscess with overlying hemorrhage.

• 

  Figure 3. B-scan ultrasonographs show dens posterior vitreous opacification and multiple abnormal vitreous spikes in both eyes.

Reference

References

1. Okada AA, Johnson RP, Liles WC. . Endogenous bacterial endophthalmitis. Report of a ten-year retrospective study. Ophthalmology. 1994; 101:832–8.

2. Liang L, Lin X, Yu A. . The clinical analysis of endogenous endophthalmitis. Yan Ke Xue Bao. 2004; 20:144–8.

3. Puliafito CA, Baker AS, Haaf J, Foster CS. Infectious endophthalmitis. Review of 36 cases. Ophthalmology. 1982; 89:921–9.

4. Greenwald MJ, Wohl LG, Sell CH. Metastatic bacterial endophthalmitis: a contemporary reappraisal. Surv Ophthalmol. 1986; 31:81–101.

5. Smith SR, Kroll AJ, Lou PL, Ryan EA.Endogenous bacterial and fungal endophthalmitis. Int Ophthalmol Clin. 2007; 47:173–83.

6. Liu YC, Cheng DL, Lin CL. Klebsiella pneumoniae liver abscess associated with septic endophthalmitis. Arch Intern Med. 1986; 146:1913–6.

7. O'Brien CJ, Kyle GM. Metastatic Staphylococcus aureus endophthalmitis: a case report. Br J Ophthalmol. 1988; 72:189–91.

8. Liao HR, Lee HW, Leu HS. . Endogenous Klebsiella pneumoniae endophthalmitis in diabetic patients. Can J Ophthalmol. 1992; 27:143–7.

9. . . The problem of bacillus species infection with special emphasis on the virulence of Bacillus cereus. Ophthalmology. 1981; 88:833–8.

10. Lee SJ, Lee MA, Kwak HW. Clinical Aspect of Bacterial Endogenous Endophthalmitis. J Korean Ophthalmol Soc. 2000; 41:112–8.

11. La TY, Kim CW, Lee JS. A Case of Endogenous Endophthalmitis Accompanying Orbital Cellulitis Caused by Klebsiella Pneumoniae from Liver Abscess. J Korean Ophthalmol Soc. 2000; 41:1000–5.

12. Oh TS, Ahn Y, Chang SD, Lee YK. A Case of Endogenous endophthalmitis Caused by Klebsiella Pneumoniae from Emphysematous Pyelonephritis. J Korean Ophthalmol Soc. 2002; 43:1330–4.

13. Samiy N, D'Amico DJ. Endogenous fungal endophthalmitis. Int Ophthalmol Clin. 1996; 36:147–62.

14. Parke DW 2nd, Jones DB, Gentry LO. Endogenous endophthalmitis among patients with candidemia. Ophthalmo- logy. 1982; 89:789–96.

15. Wong JS, Chan TK, Lee HM, Chee SP. Endogenous bacterial endophthalmitis: an east Asian experience and a reappraisal of a severe ocular affliction. Ophthalmology. 2000; 107:1483–91.

16. Chuang LH, Song HS, Lee SC. . Endogenous Klebsiella pneumoniae endophthalmitis associated with prostate abscess: case report. Chang Gung Med J. 2000; 23:240–5.

17. Tseng CY, Liu PY, Shi ZY. . Endogenous endophthalmitis due to Escherichia coli: case report and review. Clin Infect Dis. 1996; 22:1107–8.

18. Weishaar PD, Flynn HW Jr. . Endogenous Aspergillus endophthalmitis. Clinical features and treatment outcomes. Ophthalmology. 1998; 105:57–65.

19. Griffin JR, Pettit TH, Fishman LS. Foos RY. Blood-borne Candida endophthalmitis. A clinical and pathologic study of 21 cases. Arch Ophthalmol. 1973; 89:450–6.

20. Edwards JE Jr, Foos RY, Montgomerie JZ, Guze LB. Ocular manifestations of Candida septicemia: review of seventy-six cases of hematogenous Candida endophthalmitis. Medicine (Baltimore). 1974; 53:47–75.

21. Binder MI, Chua J, Kaiser PK. . Endogenous endophthalmitis: an 18-year review of culture-positive cases at a tertiary care center. Medicine (Baltimore). 2003; 82:97–105.