Bilateral endogenous Candida albicans subretinal abscess with suspected mixed bacterial infection

Abstract

Yusuke Arai,1 Yukihiro Sato,1 Atsushi Yoshida,1 Hidetoshi Kawashima,1 Toshikatsu Kaburaki,2 Harumi Gomi3 1Department of Ophthalmology, Jichi Medical University, Tochigi, Japan; 2Department of Ophthalmology, The University of Tokyo, Graduate School of Medicine, Tokyo, Japan; 3Center for Clinical Infectious Diseases, Jichi Medical University, Tochigi, Japan Purpose: Candida albicans subretinal abscess is extremely rare. To our knowledge, only one unilateral case has been reported. Herein, we report one bilateral case. Mixed bacterial infection was also suspected based on broad-range real-time polymerase chain reaction.Methods: A 64-year-old man being treated with oral corticosteroids for interstitial pneumonia visited us for visual loss in the left eye. Best corrected visual acuity (BCVA) was 20/20 in the right eye and 8/200 in the left eye. Funduscopy revealed round yellowish-white subretinal lesions with retinal hemorrhage in both eyes.Results: Broad-range polymerase chain reaction of the vitreous fluid from the left eye showed a high copy count of bacterial 16s ribosome RNA. Despite large doses of antibiotics, the abscess expanded and vision decreased to light perception in the left eye. Exenteration of the left eye was performed followed by microscopic examination showing Gram-negative bacilli, and C. albicans was also cultured. Antibiotics and the maximum doses of antifungal drugs were administered. However, the abscess in the right eye expanded, and BCVA decreased to 2/200. Vitrectomy and silicone oil tamponade were performed. Vitreous fluid culture revealed C. albicans. At 16 months follow-up, BCVA was stable at 4/200 with healing of the subretinal abscess under silicone oil.Conclusion: Since C. albicans subretinal abscess is extremely rare and there was a concurrent mixed bacterial infection, diagnostic procedures in our bilateral case were more complicated than usual. C. albicans infection should be included in the differential diagnosis of subretinal abscesses. Keywords: Candida albicans, subretinal abscess, mixed infection