Endogenous endophthalmitis from Fusarium spp. in a patient with onychomycosis: A case report
Endogenous or metastatic endophthalmitis is a rare intraocular infection whose incidence has upraised in the last decades. We describe herein a 59 years old diabetic man who developed a fungal endogenous endophthalmitis secondary to a complicated onycho-mycosis of the first right toe. The patient had a past ocular history of misdiagnosis of non-infectious panuveitis and a failed treatment with high-dose systemic, periocular and topical corticosteroids. The patient decided to take a second opinion because of worsening of red eye, progressive visual loss, moderate ocular pain, tearing and photophobia in the left eye after a four-day period post-transeptal injection of 40 mg depot methyl-prednisolone. Upon arrival to our Service, an urgent vitreous and aqueous tap, as well as a nail biopsy of the first right toe were performed. Smear and culture results from the vitreous and nail toe came back positive for Fusarium spp., confirming the diagnosis of fungal endogenous endophthalmitis. The patient was aggressively treated with two intravitreal amphotericin-B (0.5 mg/0.1 ml) injections, topical 5% nathamycin, and systemic fluconazole (300 mg q.d. PO) for several weeks despite of which, and due to the advanced state of infection and previous erroneous massive steroid therapy, the visual outcome was unfavorable. To the best of our knowledge, this is the first case report of metastatic Fusarium endophthalmitis secondary to a complicated toe onychomycosis.