Posters

Bilateral endogenous endophthalmitis secondary to fungal emboli

Poster Details

First Author: G. Moussa UNITED KINGDOM

Co Author(s):    J. Panthagani   S. Shakir   S. Madge              

Abstract Details

Purpose:

To describe the first reported case of bilateral endogenous endophthalmitis secondary to fungal septic emboli originating from the sphenoidal sinus spreading to the cavernous sinus and the internal carotid artery, in an immunocompetent 87-year-old Caucasian gentleman.

Setting:

Acute admission for 87-year-old hospital with loss of vision presenting at Hereford County Hospital, UK.

Methods:

Inpatient ophthalmic care with regular review, photography, MRI, PET, CT Angiography, blood tests, vitreous biopsy investigations.

Results:

A patient with radiotherapy treated sphenoidal sinus malignancy 20 years previously, presented with acute loss of vision in the right eye (RE). Visual acuity (VA) RE: CF. RE showed vitritis and multiple areas of haemorrhagic retinal necrosis; LE normal. Vitrectomy with biopsy showed negative culture and PCR and found full thickness retinal necrosis with fungal-like subretinal collections. After multiple TIAs, MRI found multiple recent embolic infarcts throughout distribution of right thickened internal carotid, and sphenoidal sinus thickening; this grew Aspergillus versicolor on endoscopy. Retinal tissue gram stain showed gram-positive filamentous branching rods. LE developed the same lesions after 2 weeks.

Conclusions:

This case describes systemic pathology presenting in the eye in a novel manner. We discuss the diagnostic challenge and journey in this complicated case. Unfortunately, the patient passed away despite maximal treatment and investigation with full collaboration between specialities. We hope to provide insight to other similar complex cases.

Financial Disclosure:

NONE