Resolution of Coccidioides immitis endophthalmitis with an aggressive surgical and medical therapeutic approach

Semin Ophthalmol. 2013 Jul;28(4):251-2. doi: 10.3109/08820538.2013.788677. Epub 2013 May 2.

Abstract

Introduction: Coccidioides immitis endophthalmitis usually results in enucleation, and there is evidence that vitrectomized eyes are more likely to become enucleated.

Methods: A 55-year-old man presented to us with steroid-resistant granulomatous uveitis and was eventually diagnosed with C. immitis endophthalmitis. He was treated with an aggressive medical and surgical approach, receiving a total of 16 intravitreal antifungal injections and three vitrectomies, as well as lensectomy and penetrating keratoplasty.

Results: At 13 months after presentation, the patient's eye was free of inflammation, and his best corrected visual acuity was 20/25.

Discussion: This is the first reported case of culture-proven C. immitis endophthalmitis with a favorable final outcome. We propose that the good outcome may have been due to our aggressive therapeutic approach.

Publication types

  • Case Reports

MeSH terms

  • Antifungal Agents / therapeutic use*
  • Coccidioides / isolation & purification*
  • Coccidioidomycosis / diagnosis
  • Coccidioidomycosis / microbiology
  • Coccidioidomycosis / therapy*
  • Combined Modality Therapy
  • Endophthalmitis / diagnosis
  • Endophthalmitis / microbiology
  • Endophthalmitis / therapy*
  • Eye Infections, Fungal / diagnosis
  • Eye Infections, Fungal / surgery
  • Eye Infections, Fungal / therapy*
  • Humans
  • Male
  • Middle Aged
  • Pyrimidines / therapeutic use
  • Treatment Outcome
  • Triazoles / therapeutic use
  • Visual Acuity
  • Vitrectomy*
  • Voriconazole

Substances

  • Antifungal Agents
  • Pyrimidines
  • Triazoles
  • Voriconazole