Оппортунистический камбаларийский грибок эндофтальмит в фумаратно обработанном множестве склероза, осложненный многофукаловой постинфекционной васкулопатией.

Opportunistic Quambalaria fungal endophthalmitis in fumarate-treated multiple sclerosis complicated by multifocal postinfectious cerebral vasculopathy.

PURPOSE: To describe the clinical course, multimodal imaging, management, and outcome of a case of endogenous Quambalaria fungal endophthalmitis.

METHODS

Single-patient case report.

RESULTS

A 66-year-old man with newly diagnosed multiple sclerosis on fumarate therapy treated with oral corticosteroids for a presumed intermediate uveitis, developed progressive left intraocular inflammation. Referral to a quaternary centre and diagnostic vitreous sampling identified Quambalaria cyanescens. on culture and panfungal polymerase chain reaction . A route of infection could not be established with certainty: a preceding ocular injury with plant material and an earlier lower-limb cellulitis each offered a plausible mechanism Despite intravitreal anti-fungal therapy, two pars plana vitrectomies and systemic antifungals, inflammation persisted until a period of intensive, repeated intravitreal voriconazole injections administered during inpatient admission resulted in clinical regression. Multifocal cerebral vasculopathy occurred in the immune reconstitution phase following improvement of Quambalaria infection.

CONCLUSION

Quambalaria is an exceptionally rare ocular pathogen that can cause aggressive endophthalmitis. . Vitrectomy and intensive intravitreal voriconazole arrested an infection that had progressed despite treatment; the globe was preserved, although final visual acuity was light perception.