Post-operative endophthalmitis caused by Acremonium falciforme with orbital and extra-orbital involvement following combined cataract and glaucoma surgery: a case report

J Med Case Rep. 2014 Nov 19:8:373. doi: 10.1186/1752-1947-8-373.

Abstract

Introduction: In this report, we describe an unusual case of post-operative Acremonium falciforme endophthalmitis with orbital and extra-orbital involvement following combined cataract and glaucoma surgery.

Case presentation: A 68-year-old Caucasian man with glaucoma presented with endophthalmitis characterized by pain, redness and impaired vision in the left eye fifteen days after combined cataract and filtering surgery. He subsequently underwent a pars plana vitrectomy, with vitreous sampling, silicone oil placement and intra-vitreal injection of antibiotics, but only after a second vitrectomy we identified Acremonium falciforme as the causative agent for the endophthalmitis. An antifungal systemic and topical therapy was started, but meanwhile the infection extended to orbital and peri-orbital tissues. Following these procedures, even if the eye went slowly in phthisis, we were able to limit the further extension and circumscribe the orbital and extra-orbital involvement.

Conclusion: To our knowledge, this report is the first describe Acremonium falciforme endophthalmitis with orbital and extra-orbital involvement, following anterior segment combined surgery. Ophthalmologists and physicians should be aware of the extension risk of a fungal panophthalmitis, but also to potentially serious side effects related to systemic therapy.

Publication types

  • Case Reports

MeSH terms

  • Acremonium*
  • Aged
  • Antifungal Agents / administration & dosage
  • Antifungal Agents / therapeutic use
  • Cataract Extraction / adverse effects*
  • Cataract Extraction / methods
  • Endophthalmitis / diagnosis
  • Endophthalmitis / etiology*
  • Endophthalmitis / microbiology
  • Eye Infections, Fungal / diagnosis
  • Eye Infections, Fungal / etiology*
  • Eye Infections, Fungal / microbiology
  • Filtering Surgery / adverse effects*
  • Filtering Surgery / methods
  • Humans
  • Intravitreal Injections
  • Male
  • Orbit / microbiology

Substances

  • Antifungal Agents