Bilateral Endogenous Cryptococcal Endophthalmitis in an Immunocompetent Host Treated with Two Different Tailored Approaches

Abstract

Endogenous fungal endophthalmitis is one of the most severe and rare ocular pathologies. Rarely, it occurs in healthy and immunocompetent people and is observed in both eyes. This case report describes diagnosis and treatment of a rare case of bilateral endogenous fungal endophthalmitis with different degree of severity. Smear and culture of vitreous samples were not helpful in confirming the aetiology but blood samples revealed Cryptococcus neoformans antigen. Systemic therapy was set up with voriconazole. Vitrectomy with intravitreal injection of voriconazole was performed in left eye as it was clincally worst, while only intravitreal injection of antifungal drug was performed in right eye. After 3 months of follow-up, a relevant functional and morphologic improvement was reported in both eyes. Cryptococcal endogenous endophthalmitis is a challenge for ophthalmologists. Prompt aggressive treatments tailored to the known aetiology and clinical conditions are imperative to achieve good morpho-functional recovery in case of bilateral involvement with different degree of severity.

Keywords

• cryptococcus neoformans
• endogenous endophthalmitis
• intravitreal injection
• vitrectomy
• voriconazole