Purpose: To report a case of binocular fungal endophthalmitis associated with complicated pyelonephritis without immunocompromised status.
Case report: An 82-year-old healthy woman who underwent bilateral penetrating keratoplasty more than 10-years previous developed complicated pyelonephritis which became less severe via antibiotics therapy at another hospital. No specific causative pathogens of complicated pyelonephritis were identified, and post pyelonephritis treatment she presented at our hospital due to blurred vision. Since inflammatory cells were observed in both anterior chambers, she was diagnosed with uveitis and underwent steroid eye-drop treatment. One week later, hypopyon in her left eye and white lesions on both retinas occurred. There was no evidence of sepsis because of blood culture-negative and no increase in inflammation markers, including procalcitonin, β-D-glucan and C-reactive protein. On day2 and day8 post admission, vitreous surgery was performed in her right and left eye, respectively. Since Candida albicans was cultured in her left-eye vitreous samples, all signs of fungal infection improved post fungal treatment, and the same Candida albicans was cultured in urinary lithiasis at a later date, we diagnosed her with endogenous fungal endophthalmitis.
Conclusions: Endogenous fungal endophthalmitis should be considered in patients with pyelonephritis even without immunosuppression.
Nippon Ganka Gakkai Zasshi (J Jpn Ophthalmol Soc) 123: 1095-1100, 2019.