A case of Purpureocillium lilacinum endophthalmitis initially diagnosed as acute anterior uveitis in an immunocompetent young male in Western Australia
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Yes
Purpose
To report a rare case of Purpureocillium lilacinum endophthalmitis in an immunocompetent young male, initially diagnosed as acute anterior uveitis (AAU), and to discuss the diagnostic challenges and treatment approach for this condition.
Methods
Observational case report
Results
A 29-year-old male presented with a three-week history of eye redness and blurred vision, initially diagnosed as AAU. Examination revealed hand-motion vision, and no corneal infiltrates. Significant anterior chamber (AC) inflammation with 1mm hypopyon, and posterior synechiae were noted. B-scan showed a flat retina with no vitritis. Extensive blood work and AC tap were negative. Despite aggressive treatment with steroids and antibiotics, his condition worsened. Vitreous biopsy confirmed Purpureocillium lilacinum infection. The patient underwent vitrectomy, intravitreal voriconazole injections, and oral voriconazole therapy. Further interventions included repeat vitrectomy, endolaser, and silicone oil placement. Despite multiple surgeries and antifungal therapy, visual acuity remained poor, with final best-corrected visual acuity of 6/60. Follow-up showed no active inflammation.
Conclusion
This case highlights the diagnostic challenge of distinguishing fungal endophthalmitis from acute anterior uveitis, especially in immunocompetent patients. Early diagnosis and aggressive antifungal therapy, including vitrectomy and intravitreal voriconazole, are critical, though visual outcomes are often poor. This case underscores the need for heightened awareness of fungal infections in the differential diagnosis of uveitis and the complexities in managing endogenous fungal endophthalmitis.
Conflict of interest
No
1
Last name
KOH
Initials of first name(s)
L
Department
Ophthalmology
City
Singapore
Country
Singapore
2
Last name
LIM
Initials of first name(s)
L
Department
Ophthalmology
City
Singapore
Country
Singapore
3
Last name
HOHNEN
Initials of first name(s)
H
Department
Ophthalmology
City
Perth
Country
Australia
4
Last name
TAY-KIERNEY
Initials of first name(s)
ML
Department
Ophthalmology
City
Perth
Country
Australia
5
Last name
CHEN
Initials of first name(s)
F
Department
Ophthalmology
City
Perth
Country
Australia
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