Офтальмохирургия (Jul 2019)
Fungal endophthalmitis
Abstract
The article presents a clinical case of fungal endophthalmitis, the causative agent of which was Paecilomyces lilacinum. Patient M., female, 1947 year of birth was operated on for complicated cataract of the right eye. Two weeks later, she complained of decreased vision. A local anti-inflammatory therapy of the exudative reaction in the anterior chamber was carried out, therefore an improvement was achieved. Two weeks later, the patient again complained of visual impairment. Лечение было продолжено со сменой фунгицидных средств, обладающих большим Systemic and local anti-inflammatory and antibacterial therapy of exudative uveitis with the course of fluconazole for 15 days was carried out. Extended clinical and laboratory studies did not reveal any chronic inflammatory and immune diseases in the female patient. In connection with the further progression of the process, vitrectomy was performed with the removal of IOL and washing of the vitreous cavity with a solution of vancomycin. The achieved stabilization lasted short. There were appeared signs indicating a fungal etiology of the inflammatory process. Taking into account the previous long-term antibiotic therapy, yeast contamination was suggested. Despite the active treatment, there was a further deterioration of the eye. No pathogenic and conditionally pathogenic microflora growth was revealed as a result of seeding. Confocal microscopy revealed a filamentous structure of the mycelium in the thickness of the corneal stroma, which indicated infection with mold, not yeast fungi. Treatment was continued with a change of fungicidal agents with a large spectrum of action, as well as a silicone oil tamponade. The obtained culture was aimed at identification of the species and determination of sensitivity to fungicides in the medical scientific and practical center for tuberculosis control, Moscow. Cultural studies identified pathogenic microflora – Paecilomyces lilacinum, sensitive to ketoconazole. In connection with the spread of infection to the periorbital tissues, with the subsequent probability of systemic damage, an emergency enucleation of the eyeball was decided. This example indicates the need for increased alertness for fungal infection in cases of atypical flow of intraocular inflammation, the search for methods for early detection of the pathogen.
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