Unilateral endogenous fungal endophthalmitis after esophageal cancer surgery: a case report
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This study reports a case of Unilateral Endogenous Fungal Endophthalmitis After Esophageal Cancer Surgery.
One patient presented with a month-long loss of vision in his left eye, he had surgery for esophageal cancer 2 months earlier. The patient underwent cataract surgery (by phacoemulsification) in the left eye combined with 25-gauge vitrectomy and silicone oil tamponade. The microbiological culture pointed to infection with Candida albicans. At 3-month follow-up, the unaided visual acuity of left eye was 0.02 and corrected visual acuity was 0.2. In addition, there was no recurrence of the endophthalmitis within 1 year of the surgery.
The early diagnosis of endogenous fungal endophthalmitis is difficult, and the disease is very likely to be misdiagnosed as uveitis. It is therefore critical to improve awareness of this condition and to reduce the incidence of its misdiagnosis.
KeywordsEndogenous Fungal Endophthalmitis Postcancer surgery Case report
Endogenous endophthalmitis is an infection due to fungi or bacteria that enter the eye through the circulating blood, causing inflammation of intraocular tissues such as the vitreous body and retina. Endogenous endophthalmitis accounts for 2 to 15% of all cases of endophthalmitis [1, 2]. Herein we report one cases of Unilateral Endogenous Fungal Endophthalmitis After Esophageal Cancer Surgery.
Discussion and conclusions
Endogenous fungal endophthalmitis is characterized by its low incidence, insidious onset, and high degree of destructiveness, which can lead to atrophy of the eyeball and permanent visual impairment. The risk factors for endogenous fungal endophthalmitis include systemic diseases (e.g., diabetes, liver cirrhosis, malignant tumors, and acquired immunodeficiency syndrome) and/or the presence of an infectious lesion (e.g., liver abscess, meningitis, and lung abscess) [2, 3, 4]. Among all cases of endogenous fungal endophthalmitis, endogenous C. albicans endophthalmitis is the most common type, representing 75 to 80% of the cases; Aspergillus is the second most common causative organism [5, 6, 7]. The effective treatment of endogenous fungal endophthalmitis rests on the combination of timely vitrectomy and systemic antifungal therapy. In addition, silicone oil has antimicrobial activity against Staphylococcus aureus, Pseudomonas aeruginosa, and C. albicans [8, 9]. The patient reported here, who suffered from endogenous C. albicans endophthalmitis, had the risk factor of a malignant tumor. Before we operated on his eye, the endophthalmitis had progressed to stage III (vitreous opacity), and the eye could only perceive light. Following timely surgery and antifungal treatment, we were able to restore partial visual function to the affected eye. In general, the early diagnosis of endogenous fungal endophthalmitis is difficult, and the disease is very likely to be misdiagnosed as uveitis. Moreover, with the improper use of steroids or immunosuppressive agents, endogenous fungal endophthalmitis can rapidly progress. In recent years, in the context of the increased use of intravenous drugs and the application of immunosuppressive agents, the incidence of endogenous fungal endophthalmitis has tended to increase. It is therefore critical to improve awareness of this condition and to reduce the incidence of its misdiagnosis.
This study is supported by the Natural Science Foundation of Ningbo City (2017A610237).and by the Projects of medical and health technology development program in Zhejiang province (2017KY619).
Availability of data and materials
The data supporting conclusions of this article are included within this article.
Q.Y. and W.L. were involved with the design of the research. Q.Y. performed the surgery. L.C. and Z.B. assembled and analyzed the data. All of the authors reviewed the data and participated in the writing of the manuscript. All authors read and approved the final manuscript.
Ethics approval and consent to participate
Consent for publication
Written informed consent was obtained from the patient for publication of this Case Report and any accompanying images.
The authors declare that they have no competing interests.
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