ASPERGILLUS ENDOPHTHALMITIS SECONDARY TO INFECTIOUS SCLERITIS: UTILITY OF DIAGNOSTIC POLYMERASE CHAIN REACTION.

PURPOSE: To describe a case of delayed-onset Aspergillus fumigatus endophthalmitis secondary to infectious fungal scleritis diagnosed with a broad-range polymerase chain reaction from scleral nodular debridement and vitreous sampling during vitrectomy.

METHODS

Retrospective case report with slit-lamp photography, optical coherence tomography, and fundus photography.

RESULTS

A 76-year-old man presented with worsening vision and pain in his right eye, concerning for progressive nodular scleritis and endophthalmitis, 8 months following a reportedly innocuous tree branch injury. Following the injury, he underwent an magnetic resonance imaging (MRI), surgical exploration, subconjunctival antibiotic administration, and culturing due to persistent foreign body sensations. Cultures were negative, and the patient was started on oral nonsteroidal anti-inflammatory drugs (NSAIDs), oral prednisone, and periocular triamcinolone injections following negative/normal infectious and rheumatologic workup for scleritis. The patient was referred for worsened scleritis with development of endophthalmitis. He underwent lamellar sclerectomy, debridement, and culture of purulent material from scleral nodules in coordination with diagnostic vitrectomy, vitreous sampling, and subconjunctival and intravitreal antibiotic and antifungal treatment. The broad-range polymerase chain reaction was positive for A. fumigatus , and targeted antifungal treatment was initiated. The eye did not regain visual function and was enucleated for progressive pain 6 months following diagnosis.

CONCLUSION

Fungal scleritis and endophthalmitis result in significant morbidity. Diagnostic vitrectomy and the broad-range polymerase chain reaction can aid in prompt diagnosis and targeted treatment and may be useful in refractory cases.