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Endogenous Fusarium Endophthalmitis During Treatment for Acute Myeloid Leukemia, Successfully Treated with 25-Gauge Vitrectomy and Antifungal Medications

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Abstract

Endogenous fungal endophthalmitis (EFE) caused by disseminated fusariosis is a rare condition that generally has a poor outcome, even with intensive therapy. Here, we describe a case in which this type of EFE was diagnosed with vitreous sampling and was successfully treated with 25-gauge vitrectomy and antifungals, including liposomal amphotericin B and voriconazole. A 16-year-old male patient undergoing treatment for acute myeloid leukemia complained of eye pain and blurred vision in his right eye. Treatment was initiated for a vitreous opacity, possibly associated with herpetic retinitis, but the patient worsened and he was referred to us. Right-eye visual acuity was limited to light perception. We suspected endogenous endophthalmitis and performed 25-gauge vitrectomy with antibiotic perfusion of ceftazidime, vancomycin, and voriconazole. Vitreous culturing revealed the presence of Fusarium solani species complex, and enhanced computed tomography revealed disseminated fusariosis lesions in the lung, spleen, and the soft tissue of the left upper arm. The patient received antifungal treatment with liposomal amphotericin B and voriconazole, and these conditions were eliminated. Visual acuity recovered to 20/400 after additional vitrectomy for tractional retinal detachment and was maintained at this level during the 6-month follow-up period. The success of our treatment allowed the capture of optical coherence tomography images of the retina during fusarium-associated endogenous endophthalmitis and the follow-up period. Furthermore, this case showed that immediate vitrectomy for suspected EFE and intensive treatment can lead to a good clinical outcome.

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Acknowledgements

The authors thank Mr. Tim Hilts for reviewing this manuscript.

Author information

Author notes

  1. Kazuichi Maruyama

    Present address: Department of Innovative Visual Science, Osaka University Medical School, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan

  2. Masaaki Yoshida and Naoki Kiyota contributed equally to this work.

Authors and Affiliations

  1. Department of Ophthalmology, Tohoku University Graduate School of Medicine, 1-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan

    Masaaki Yoshida, Naoki Kiyota, Kazuichi Maruyama, Hiroshi Kunikata & Toru Nakazawa

  2. Department of Laboratory Medicine, Tohoku University Hospital, Sendai, Japan

    Masahiro Toyokawa

  3. Preparing Section for New Faculty of Medical Science, Fukushima Medical University, Fukushima, Japan

    Masahiro Toyokawa

  4. Teikyo University Institute of Medical Mycology, Tokyo, Japan

    Shigehiro Hagiwara & Koichi Makimura

  5. Department of Pathology, Tohoku University Hospital, Sendai, Japan

    Naomi Sato & Shinji Taniuchi

Authors
  1. Masaaki Yoshida
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Correspondence to Kazuichi Maruyama.

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Yoshida, M., Kiyota, N., Maruyama, K. et al. Endogenous Fusarium Endophthalmitis During Treatment for Acute Myeloid Leukemia, Successfully Treated with 25-Gauge Vitrectomy and Antifungal Medications. Mycopathologia 183, 451–457 (2018). https://doi.org/10.1007/s11046-017-0221-x

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  • DOI: https://doi.org/10.1007/s11046-017-0221-x

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