American journal of ophthalmology case reports · 2025
Unusual presentation of fungal keratitis and endogenous endophthalmitis in Sézary syndrome: a case report.
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Fernández-Gurría Marta, Kwan Jennifer, Dimitropoulou Nina, Dhillon Navpreet
Аннотация
PURPOSE: This report describes an atypical presentation of Candida keratitis and subsequent endogenous bacterial endophthalmitis in a patient with Sézary Syndrome undergoing immunotherapy and subsequently chemotherapy.
OBSERVATIONS: A male patient in his late sixties, a rigid gas permeable (RGP) contact lens wearer diagnosed with Sézary Syndrome and undergoing immunotherapy, presented with blurred vision and pain in the right eye. Examination showed a pseudodendritic infiltrate, severe anterior chamber inflammation with hypopyon and B-scan ultrasonography was unremarkable. Herpetic keratouveitis was suspected, and treatment was started with oral acyclovir, topical levofloxacin, and topical dexamethasone, with no improvement after 48 hours. Cultures identified Candida albicans and treatment was swapped to hourly topical levofloxacin, amphotericin B, voriconazole, and systemic voriconazole, which improved the presentation. However, the patient developed complete pupil occlusion and pupillary block with raised intraocular pressure, which was controlled with medical treatment. One month later, after a chemotherapy cycle, the hypopyon recurred despite improvement of the corneal infiltrate, and B-ultrasonography showed vitritis. Vitreous tap and intravitreal injections were performed, and cultures identified Bacillus cereus and Corynebacterium species. The endogenous endophthalmitis resolved with treatment, but the patient developed retinal detachment, which was managed conservatively. Unfortunately, he passed away three months later, despite infection resolution and stabilization of ocular symptoms.
CONCLUSION: This case highlights the complex relationship between systemic immunosuppression, ocular susceptibility and opportunistic endogenous infections, contributing to a challenging clinical course, diagnosis and treatment of patients with Sézary Syndrome. Clinicians should be aware of this risk of atypical and aggressive infectious presentations and carefully monitor these patients after chemotherapy cycles to detect potential complications early.
OBSERVATIONS: A male patient in his late sixties, a rigid gas permeable (RGP) contact lens wearer diagnosed with Sézary Syndrome and undergoing immunotherapy, presented with blurred vision and pain in the right eye. Examination showed a pseudodendritic infiltrate, severe anterior chamber inflammation with hypopyon and B-scan ultrasonography was unremarkable. Herpetic keratouveitis was suspected, and treatment was started with oral acyclovir, topical levofloxacin, and topical dexamethasone, with no improvement after 48 hours. Cultures identified Candida albicans and treatment was swapped to hourly topical levofloxacin, amphotericin B, voriconazole, and systemic voriconazole, which improved the presentation. However, the patient developed complete pupil occlusion and pupillary block with raised intraocular pressure, which was controlled with medical treatment. One month later, after a chemotherapy cycle, the hypopyon recurred despite improvement of the corneal infiltrate, and B-ultrasonography showed vitritis. Vitreous tap and intravitreal injections were performed, and cultures identified Bacillus cereus and Corynebacterium species. The endogenous endophthalmitis resolved with treatment, but the patient developed retinal detachment, which was managed conservatively. Unfortunately, he passed away three months later, despite infection resolution and stabilization of ocular symptoms.
CONCLUSION: This case highlights the complex relationship between systemic immunosuppression, ocular susceptibility and opportunistic endogenous infections, contributing to a challenging clinical course, diagnosis and treatment of patients with Sézary Syndrome. Clinicians should be aware of this risk of atypical and aggressive infectious presentations and carefully monitor these patients after chemotherapy cycles to detect potential complications early.