Scopulariopsis fungal endophthalmitis after cataract surgery requiring enucleation.

PURPOSE: To report a rare case of post-cataract surgery related endophthalmitis caused by Scopulariopsis species and describe the therapeutic challenges associated with this multidrug-resistant opportunistic fungal pathogen.

CASE DESCRIPTION: A 74-year-old immunocompromised female developed chronic endophthalmitis three months after cataract surgery in Africa. Vitreous culture revealed polymicrobial infection with Scopulariopsis species demonstrating resistance to azole antifungals but susceptibility to micafungin. Despite aggressive treatment including pars plana vitrectomy, systemic micafungin, and intravitreal amphotericin B injections, the patient developed phthisis bulbi and persistent pain, ultimately requiring enucleation. Histopathological examination revealed persistent fungal hyphae despite three months of intensive antifungal therapy.

CONCLUSION

Scopulariopsis endophthalmitis represents an extremely rare but devastating infection with inherent therapeutic resistance. Even with aggressive multimodal antifungal therapy guided by susceptibility testing, complete eradication may not be achievable, highlighting the importance of early recognition and realistic prognostic counseling for these challenging infections.