Case report of Acremonium intraocular infection after cataract extraction

Abstract

A 64-year-old woman was referred to our clinic for the treatment of chronic uveitis in her left eye, which had started two weeks after an uncomplicated cataract extraction. She was treated with topical steroids with an initially good response, yet she subsequently developed severe inflammation and plaque-like material around the intraocular lens, despite continuous steroid therapy. She underwent pars plana vitrectomy, smear and culture of the aqueous and vitreous fluids, and intravitreal antibiotic injection under the impression of Propionibacterium acne (P. acne) endophthalmitis. As a result of the smear and culture of the vitreous fluid identified as an Acremonium species, she was treated with intravenous amphotericin B injections for five days, followed by oral voriconazole administration. During the post-operative 18-month follow-up, she was stable without significant relapse of uveitis. In this case, the best correction of visual acuity was an improvement from 20/40 to 20/20.

Keywords: Acremonium; Cataract extraction; Endophthalmitis; Propionibacterium.

Fig. 1

Fundus photograph at the time of presentation. The left eye is hazy due to vitreous opacity (right).

Fig. 2

KOH-Calcofluor staining of vitreous fluid obtained during pars plana vitrectomy H & E, ×400. Septum of fungal hyphae (white arrow).

Fig. 3

Gram staining of the vitreous fluid collected during pars plana vitrectomy, ×1000. WBC (arrow head), septated hyphae (arrow).

Fig. 4

Anterior segment photograph taken 7 days after surgery. The thin plaque-like material (white arrow) gradually decreased over time.