The first case of fungal endogenous endophthalmitis caused by Aspergillus nidulans: Diagnostic and therapeutic challenge

Significance: Fungal endogenous endophthalmitis is an uncommon and potentially blinding infection. Aspergillus is a causative organism in immunocompromized although is virulent enough to afflict immunocompetents. Their propensity to affect macula usually results in a dismal prognosis; thus, improving visual outcome has always been challenging to clinicians. A. nidulans has only rarely been implicated in exogenous endophthalmitis. Purpose: To report the first case of A. nidulans endogenous endophthalmitis. Case report: An asthmatic 42-year-old female presented with sudden unilateral vision loss due to a submacular abscess that progressively worsened in a matter of days. Vitreous PCR analysis after an urgent vitrectomy was positive for A. nidulans with no active systemic foci found. Oral and intravitreal Voriconazole was prescribed but multiple reactivations led to three vitrectomies in total alongside with subretinal Voriconazole, abscess aspiration, and endolaser. There was complete resolution of the infection and, although visual acuity was poor due to macular scar, enucleation was avoided. Conclusion: Although uncommon, we must consider Aspergillus as the causative organism in apparently immunocompetent patients with history of recent systemic corticosteroids treatment, especially if they suffer a broncopulmonary disorder. Aspergillus is an aggressive organism so a high index of suspicion along with early diagnosis and prompt treatment is the key for better outcomes. We highlight A. nidulans as the causative agent as there are no other reported cases.

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Streptococcus salivarius endogenous endophthalmitis

BMJ Case Reports ◽

10.1136/bcr-2020-239299 ◽

2021 ◽

Vol 14 (2) ◽

pp. e239299

Author(s):

Carl-Joe Mehanna ◽

Lea Kallassi ◽

Ahmad M Mansour ◽

Rola N Hamam

Keyword(s):

Opportunistic Infections ◽

External Source ◽

Endogenous Endophthalmitis ◽

Streptococcus Salivarius ◽

Source Of Infection ◽

Transcatheter Aortic Valve ◽

History Of ◽

Atypical Presentations ◽

High Index Of Suspicion ◽

Valve Implantation

We describe a case of endogenous endophthalmitis in an elderly man caused by Streptococcus salivarius. An 88-year-old male patient with diabetes with iron deficiency anaemia and history of transcatheter aortic valve implantation presented with an insidious clinical picture of atraumatic endophthalmitis. No internal or external source could be identified. Diagnostic and therapeutic vitrectomy revealed papillomacular abscess and vitreous fluids grew S. salivarius. Despite lack of an identifiable source of infection, a high index of suspicion for atypical presentations is required in patients with multiple comorbidities that could weaken their immune system towards opportunistic infections. Early detection, microbiological evaluation and prompt treatment are critical to avoid disastrous outcomes. While S. salivarius has been implicated in cases of exogenous endophthalmitis, this is the first reported case of endogenous endophthalmitis due to S. salivarius.

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Nontuberculous Mycobacterial Endophthalmitis: Case Series and Review of Literature

10.21203/rs.3.rs-15739/v4 ◽

2020 ◽

Author(s):

Warinyupa Pinitpuwadol ◽

Nattaporn Tesavibul ◽

Sutasinee Boonsophon ◽

Darin Sakiyalak ◽

Sucheera Sarunket ◽

...

Keyword(s):

Previous History ◽

Case Series ◽

Clinical Information ◽

Visual Outcome ◽

Treatment Modalities ◽

Endogenous Endophthalmitis ◽

Treatment Regimens ◽

Department Of Ophthalmology ◽

History Of ◽

Exogenous Endophthalmitis

Abstract Background: To report three cases of nontuberculous mycobacterial (NTM) endophthalmitis following multiple ocular surgeries and to review previous literature in order to study the clinical profile, treatment modalities, and visual outcomes among patients with NTM endophthalmitis.Methods: Clinical manifestation and management of patients with NTM endophthalmitis in the Department of Ophthalmology, Faculty of Medicine, Siriraj hospital, Mahidol University, Bangkok, Thailand were described. In addition, a review of previously reported cases and case series from MEDLINE, EMBASE, and CENTRAL was performed. The clinical information and type of NTM from the previous studies and our cases were summarized.Results: We reported three cases of NTM endophthalmitis caused by M. haemophilum, M. fortuitum and M. abscessus and a summarized review of 112 additional cases previously published. Of 115 patients, there were 101 exogenous endophthalmitis (87.8%) and 14 endogenous endophthalmitis (12.2%). The patients’ age ranged from 13 to 89 years with mean of 60.5±17.7 years with no gender predominance. Exogenous endophthalmitis occurred in both healthy and immunocompromised hosts, mainly caused by cataract surgery (67.3%). In contrast, almost all endogenous endophthalmitis patients were immunocompromised. Among all patients, previous history of tuberculosis infection was identified in 4 cases (3.5%). Rapid growing NTMs were responsible for exogenous endophthalmitis, while endogenous endophthalmitis were commonly caused by slow growers. Treatment regimens consisted of macrolides, fluoroquinolones or aminoglycosides, which were continued for up to 12 months. Initial and final vision were generally worse than 6/60.Conclusions: NTM endophthalmitis is a serious intraocular infection that leads to irreversible loss of vision. The presentation can mimic a chronic recurrent or persistent intraocular inflammation. History of multiple intraocular surgeries or immune-deficiency in patient with chronic panuveitis should raise the practioner’s suspicion of NTM endophthalmitis. Appropriate diagnosis and treatment are important to optimize visual outcome.

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Nontuberculous Mycobacterial Endophthalmitis: Case Series and Review Literature

10.21203/rs.3.rs-15739/v5 ◽

2020 ◽

Author(s):

Warinyupa Pinitpuwadol ◽

Nattaporn Tesavibul ◽

Sutasinee Boonsophon ◽

Darin Sakiyalak ◽

Sucheera Sarunket ◽

...

Keyword(s):

Previous History ◽

Case Series ◽

Clinical Information ◽

Visual Outcome ◽

Review Literature ◽

Treatment Modalities ◽

Endogenous Endophthalmitis ◽

Department Of Ophthalmology ◽

History Of ◽

Exogenous Endophthalmitis

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Nontuberculous Mycobacterial Endophthalmitis: Case Series and Review Literature

10.21203/rs.3.rs-15739/v3 ◽

2020 ◽

Author(s):

Warinyupa Pinitpuwadol ◽

Nattaporn Tesavibul ◽

Sutasinee Boonsophon ◽

Darin Sakiyalak ◽

Sucheera Sarunket ◽

...

Keyword(s):

Previous History ◽

Case Series ◽

Clinical Information ◽

Visual Outcome ◽

Review Literature ◽

Treatment Modalities ◽

Endogenous Endophthalmitis ◽

Department Of Ophthalmology ◽

History Of ◽

Exogenous Endophthalmitis

Abstract Background: To report three cases of nontuberculous mycobacterial (NTM) endophthalmitis following multiple ocular surgeries and to review previous literature in order to study the clinical profile, treatment modalities, and visual outcomes among patients with NTM endophthalmitis.Methods: Clinical manifestation and management of patients with NTM endophthalmitis in the Department of Ophthalmology, Faculty of Medicine, Siriraj hospital, Mahidol University, Bangkok, Thailand were described. In addition, a review of previously reported cases and case series from MEDLINE was performed. The clinical information and type of NTM from the previous studies and our cases were summarized.Results: We reported three cases of NTM endophthalmitis caused by M. haemophilum, M. fortuitum and M. abscessus and a summarized review of 95 additional cases previously published. Of 98 patients, there were 85 exogenous endophthalmitis (86.7%) and 13 endogenous endophthalmitis (13.3%). The patients’ age ranged from 13 to 89 years with mean of 61.1±18.7 years with no gender predominance. Exogenous endophthalmitis occurred in both healthy and immunocompromised hosts, mainly caused by cataract surgery (62.4%). In contrast, almost all endogenous endophthalmitis patients were immunocompromised. Among all patients, previous history of tuberculosis infection was identified in 4 cases (4.1%). Rapid growing NTMs were responsible for exogenous endophthalmitis, while endogenous endophthalmitis were commonly caused by slow growers. Treatment regimens consisted of macrolides, fluoroquinolones or aminoglycosides, which were continued for up to 12 months. Initial and final vision were generally worse than 6/60.Conclusions: NTM endophthalmitis is a serious intraocular infection that leads to irreversible loss of vision. The presentation can mimic a chronic recurrent or persistent intraocular inflammation. History of multiple intraocular surgeries or immune-deficiency in patient with chronic panuveitis should raise the practioner’s suspicion of NTM endophthalmitis. Appropriate diagnosis and treatment are important to optimize visual outcome.

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Nontuberculous Mycobacterial Endophthalmitis: Case Series and Review Literature

10.21203/rs.3.rs-15739/v2 ◽

2020 ◽

Author(s):

Warinyupa Pinitpuwadol ◽

Nattaporn Tesavibul ◽

Sutasinee Boonsophon ◽

Darin Sakiyalak ◽

Sucheera Sarunket ◽

...

Keyword(s):

Previous History ◽

Case Series ◽

Clinical Information ◽

Visual Outcome ◽

Review Literature ◽

Treatment Modalities ◽

Endogenous Endophthalmitis ◽

Department Of Ophthalmology ◽

History Of ◽

Exogenous Endophthalmitis

Abstract Background: To report three cases of nontuberculous mycobacterial (NTM) endophthalmitis following multiple ocular surgeries and to review previous literature in order to study the clinical profile, treatment modalities, and visual outcomes among patients with NTM endophthalmitis.Methods: Clinical manifestation and management of patients with NTM endophthalmitis in the Department of Ophthalmology, Faculty of Medicine, Siriraj hospital, Mahidol University, Bangkok, Thailand were described. In addition, a review of previously reported cases and case series from MEDLINE was performed. The clinical information and type of NTM from the previous studies and our cases were summarized.Results: We reported three cases of NTM endophthalmitis caused by M. haemophilum, M. fortuitum and M. abscessus and a summarized review of 95 additional cases previously published. Of 98 patients, there were 85 exogenous endophthalmitis (86.7%) and 13 endogenous endophthalmitis (13.3%). The patients’ age ranged from 13 to 89 years with mean of 61.1±18.7 years with no gender predominance. Exogenous endophthalmitis occurred in both healthy and immunocompromised hosts, mainly caused by cataract surgery (62.4%). In contrast, almost all endogenous endophthalmitis patients were either primary or secondary immunocompromised. Among all patients, previous history of tuberculosis infection was identified in 4 cases (4.1%). Rapid growing NTMs were responsible for exogenous endophthalmitis, while endogenous endophthalmitis were commonly caused by slow growers. Treatment regimens consisted of macrolides, fluoroquinolones or aminoglycosides, which were continued for up to 12 months. Initial and final vision were generally worse than 6/60. There were no significant differences of initial and final vision between exogenous and endogenous causes (p=1.000, 0.446, respectively).Conclusions: NTM endophthalmitis is a serious intraocular infection that leads to irreversible loss of vision. The presentation can mimic a chronic recurrent or persistent intraocular inflammation. History of multiple intraocular surgeries or immune-deficiency in patient with chronic panuveitis should raise the practioner’s suspicion of NTM endophthalmitis. Appropriate diagnosis and treatment are important to optimize visual outcome.

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A Rare Nonmalignant Mass of the Pancreas: Case Report and Review of Pancreatic Sarcoidosis

The American Surgeon ◽

10.1177/000313481007600116 ◽

2010 ◽

Vol 76 (1) ◽

pp. 79-84

Author(s):

Martin Wijkstrom ◽

Rabih I. Bechara ◽

Juan M. Sarmiento

Keyword(s):

Signs And Symptoms ◽

Whipple Procedure ◽

Unknown Etiology ◽

Benign Condition ◽

Pancreatic Malignancy ◽

First Case ◽

Pancreatic Involvement ◽

Positron Emission ◽

History Of ◽

High Index Of Suspicion

Sarcoidosis is a systemic granulomatous disease of unknown etiology affecting patients from all genetic backgrounds. Pancreatic involvement is rare; the first case was described on autopsy in 1937. We present a case of pancreatic sarcoidosis without a history of the disease presenting as biliary obstruction mimicking pancreatic malignancy. We also review the literature with respect to management and outcomes of similar cases. The patient described here presented with all the signs and symptoms of a pancreatic malignancy, which was confirmed on a CT scan; the positron emission tomography scan and the CA 19-9 level were also confirmatory of the suspected diagnosis. In this setting, if the mass looks resectable, a Whipple procedure would be the next logical step. However, such strategy would be aggressive management for a benign condition that could be palliated with diverting rather than resective procedures without changing the outlook of the disease. We suggest keeping a high index of suspicion in patients with a history of the disease if demographic concordance exists.

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A Rare Case of Fungal Necrotising Otitis Externa Centred on the Left Temporomandibular Joint

Case Reports in Otolaryngology ◽

10.1155/2020/8874754 ◽

2020 ◽

Vol 2020 ◽

pp. 1-7

Author(s):

A. Khan ◽

E. Omakobia ◽

S. Hasnie ◽

R. Barton ◽

P. Gopalan ◽

...

Keyword(s):

Temporomandibular Joint ◽

Antifungal Therapy ◽

Otitis Externa ◽

Pcr Analysis ◽

Causative Organism ◽

Cross Sectional ◽

Chronic Renal Impairment ◽

Cross Sectional Imaging ◽

Life Threatening ◽

High Index Of Suspicion

Introduction. Necrotising otitis externa (NOE) is a rare life-threatening complication of simple otitis externa which can be difficult to diagnose and manage. It is very rarely centred on the temporomandibular joint (TMJ). Fungi cause NOE in approximately 5–20% of patients, and a high index of suspicion is required for diagnosis, particularly when there is no improvement with prolonged topical and intravenous antibiotic therapy. Objective. To report a novel case of fungal NOE centred on the left TMJ in an immunocompromised adult male with a focus on investigations and optimal management. Case Report. A 67-year-old male with comorbid chronic renal impairment presented to our otolaryngology department with prolonged left otalgia and otorrhoea. Subsequent cross-sectional imaging demonstrated left NOE centred on the TMJ. Poor resolution with prolonged courses of systemic and topical anti-pseudomonal antibiotics prompted maxillofacial surgical input for left TMJ exploration, washout, and biopsy from the joint capsule. The causative organism was identified as Aspergillus flavus on PCR analysis. The patient was successfully treated with oral posaconazole and repeated topical insertions of amphotericin B-soaked ribbon gauze to the left ear. Discussion. A combination of various imaging modalities including CT, MRI, Tc-99, and gallium-67 are utilised in clinical practice both to diagnose NOE and subsequently monitor disease progression or resolution. Immunocompromised patients with confirmed fungal NOE may require a combination of treatments including surgical debridement and prolonged antifungal therapy for a number of months, if not lifelong, treatment. Initiating empirical antifungal therapy may be justified in some patients. However, this should be judged on a case-by-case basis and guided by discussion with the local microbiology and infectious diseases departments. However, there is no national guideline or consensus regarding treatment of these patients, especially in cases of fungal NOE.

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PRO score: predictive scoring system for visual outcomes after rhegmatogenous retinal detachment repair

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2021-320440 ◽

2021 ◽

pp. bjophthalmol-2021-320440

Author(s):

Louis Z Cai ◽

Jeffrey Lin ◽

Matthew R Starr ◽

Anthony Obeid ◽

Edwin H Ryan ◽

...

Keyword(s):

Risk Factors ◽

Retinal Detachment ◽

Scoring System ◽

Rhegmatogenous Retinal Detachment ◽

Vision Loss ◽

Visual Outcome ◽

Visual Outcomes ◽

Poor Visual Outcome ◽

History Of ◽

Endothelial Growth Factor

Background/aimsTo compare risk factors for poor visual outcomes in patients undergoing primary rhegmatogenous retinal detachment (RRD) repair and to develop a scoring system.MethodsAnalysis of the Primary Retinal detachment Outcomes (PRO) study, a multicentre interventional cohort of consecutive primary RRD surgeries performed in 2015. The main outcome measure was a poor visual outcome (Snellen VA ≤20/200).ResultsA total of 1178 cases were included. The mean preoperative and postoperative logMARs were 1.1±1.1 (20/250) and 0.5±0.7 (20/63), respectively. Multivariable logistic regression identified preoperative risk factors predictive of poor visual outcomes (≤20/200), including proliferative vitreoretinopathy (PVR) (OR 1.26; 95% CI 1.13 to 1.40), history of antivascular endothelial growth factor (VEGF) injections (1.38; 1.11 to 1.71), >1-week vision loss (1.17; 1.08 to 1.27), ocular comorbidities (1.18; 1.00 to 1.38), poor presenting VA (1.06 per initial logMAR unit; 1.02 to 1.10) and age >70 (1.13; 1.04 to 1.23). The data were split into training (75%) and validation (25%) and a scoring system was developed and validated. The risk for poor visual outcomes was 8% with a total score of 0, 17% with 1, 29% with 2, 47% with 3, and 71% with 4 or higher.ConclusionsIndependent risk factors were compared for poor visual outcomes after RRD surgery, which included PVR, anti-VEGF injections, vision loss >1 week, ocular comorbidities, presenting VA and older age. The PRO score was developed to provide a scoring system that may be useful in clinical practice.

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A painful red eye in an intravenous drug abuser: When not everything is what it seems

European Journal of Ophthalmology ◽

10.1177/11206721211060151 ◽

2021 ◽

pp. 112067212110601

Author(s):

Mariana Leuzinger-Dias ◽

Gonçalo Godinho ◽

Mário Lima-Fontes ◽

Cláudia Oliveira-Ferreira ◽

Elisa Camisa ◽

...

Keyword(s):

Vision Loss ◽

Clinical Signs ◽

Significant Risk ◽

Human Leukocyte ◽

Intravenous Drug ◽

Endogenous Endophthalmitis ◽

Ocular Infection ◽

Injectable Drug ◽

Red Eye ◽

History Of

Introduction Endogenous endophthalmitis is a rare but devastating ocular infection, resulting from microbial seeding of the eye during bacteremia or fungemia. Among other sources of septicemia, intravenous drug abuse is a significant risk factor, and endogenous endophthalmitis should always be thought of in any patient with a history of injectable drug use, presenting with a painful vision loss and a red inflamed eye. Case Description We report the case of a 47-year-old male, with a history of injectable drug consumption, who presented to our emergency department complaining of a painful red eye and recent deterioration of visual acuity. After the first clinical hypothesis of endogenous endophthalmitis being considered, the final diagnosis of Human Leukocyte Antigen (HLA) B27-associated acute anterior uveitis was established. Conclusion Ocular inflammation is one of the most challenging fields in all ophthalmology. Several inflammatory disorders, ranging from a wide variety of infectious and non-infectious conditions, can present themselves with the same clinical signs and symptoms, making their diagnosis extremely defiant.

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Nontuberculous Mycobacterial Endophthalmitis: Case Series and Review Literature

10.21203/rs.3.rs-15739/v1 ◽

2020 ◽

Author(s):

Warinyupa Pinitpuwadol ◽

Nattaporn Tesavibul ◽

Sutasinee Boonsophon ◽

Darin Sakiyalak ◽

Sucheera Sarunket ◽

...

Keyword(s):

Previous History ◽

Case Series ◽

Clinical Information ◽

Visual Outcome ◽

Review Literature ◽

Endogenous Endophthalmitis ◽

Department Of Ophthalmology ◽

History Of ◽

Exogenous Endophthalmitis ◽

Almost All

Abstract Background : To report three cases of nontuberculous mycobacterial (NTM) endophthalmitis following multiple ocular surgeries and to review previous literature of NTM endophthalmitis. Methods : Clinical manifestation and management of patients with NTM endophthalmitis in the Department of Ophthalmology, Faculty of Medicine, Siriraj hospital, Mahidol University, Bangkok, Thailand were described. In addition, a review of previously reported cases and case series from MEDLINE was performed. The clinical information and type of NTM from the previous studies and our cases were summarized. Results : We reported three cases of NTM endophthalmitis caused by M. haemophilum , M. fortuitum and M. abscessus and a summarized review of 95 additional cases previously published. Of 98 patients, there were 85 exogenous endophthalmitis (86.7%) and 13 endogenous endophthalmitis (13.3%). The patients’ age ranged from 13 to 89 years with mean of 61.1±18.7 years with no gender predominance. Exogenous endophthalmitis occurred in both healthy and immunocompromised hosts, mainly caused by cataract surgery (62.4%). In contrast, almost all endogenous endophthalmitis patients were either primary or secondary immunocompromised, previous history of disseminated NTM infection was identified in 38.5% of cases. Rapid growing NTMs were responsible for exogenous endophthalmitis, while endogenous endophthalmitis were commonly caused by slow growers. Initial and final vision were generally worse than 6/60. There were no significant differences of initial and final vision between exogenous and endogenous causes (p=1.000, 0.446, respectively). Conclusions : NTM endophthalmitis is a serious intraocular infection that leads to irreversible loss of vision. The presentation can mimic a chronic recurrent or persistent intraocular inflammation. History of multiple intraocular surgeries or immune-deficiency in patient with chronic panuveitis should raise the practioner’s suspicion of NTM endophthalmitis. Appropriate diagnosis and treatment are important to optimize visual outcome.

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