Infectious endotheliitis: a rare case of presumed mycotic origin

Abstract

Purpose: To report an interesting case of infectious endotheliitis of presumed mycotic origin.

Methods: A case report of a 56-year-old male farmer who sought medical attention after a month-long evolution of irritative symptoms in his right eye, accompanied by visual acuity (VA) impairment. The patient received topical and oral broad-spectrum antibiotic treatment with no improvement before being referred to a cornea specialist, where he was found to have VA of 20/150 and was noted on biomicroscopy to have endothelial feathery coalescent lesions. The patient was admitted to the hospital for an aqueous humor sample and intravenous voriconazole.

Results: The microbiological studies did not isolate any micro-organisms. However, clinical evidence of improvement was confirmed after 5 days of antimycotic intravenous therapy. Complete clinical resolution was achieved at 1 month after treatment completion with oral voriconazole, as evidenced by VA of 20/20 and disappearance of endothelial lesions.

Conclusion: Endothelial involvement by fungi is a rare condition. In this case, no microbes were isolated, but the characteristic morphology of the lesions, the history of onychomycosis, and the spectacular response to voriconazole turn this case into a valid presumptive diagnosis.

Keywords: endotheliitis; keratitis; mycotic; voriconazole.

Figure 1

(A) Endothelial lesions at admission: multiple coalescent circular lesions of feathery and whitish appearance on the endothelium with intact epithelium. (B) Reduction of the lesions after 3 days of intravenous voriconazole. (C) Complete resolution after 1 month of oral voriconazole.