Bilateral endogenous Fusarium solani endophthalmitis in a liver-transplanted patient: a case report

Abstract

Introduction: Endogenous Fusarium endophthalmitis is a rare disease predominantly described in immunocompromised patients often due to leukemia. We report a case of bilateral endogenous Fusarium solani endophthalmitis in a liver-transplanted patient.

Case presentation: A 56-year-old Danish Caucasian woman who had undergone two liver transplantations, developed endogenous endophthalmitis of her left eye 10 days after the second liver transplantation. Despite continuous therapy, enucleation of her left eye was eventually necessary; at this point funduscopic examination of her right eye disclosed a white inflammatory plaque at the macula consistent with a fungal infection. Microbiological analysis of vitreous fluid from her enucleated left eye revealed Fusarium solani, and light microscopy of her enucleated eye was consistent with Fusarium panophthalmitis with massive ingrowth of the fungi in all areas containing basement membrane collagen. Voriconazole was injected intravitreally in her right eye, and intravenous voriconazole was initiated. No subsequent growth in the inflammatory plaque was observed. She died 6 weeks after the endogenous endophthalmitis was diagnosed.

Conclusions: This is the first report of endogenous Fusarium solani endophthalmitis in a liver-transplanted patient. Ophthalmologists and physicians dealing with liver transplantation should be aware of the potential for postoperative endophthalmitis due to rare microorganisms, such as Fusarium solani.

Figure 1

Micrograph of the enucleated eye with Fusarium. Bars = 100μm, periodic acid–Schiff stains. (A) Cornea with hyphae, note their increasing density towards Descemet’s membrane. Insert: higher power of hyphae in Descemet’s membrane. (B) Posterior chamber with hyphae extending from the iris and ciliary body. (C) Posterior lens capsule infiltrated by hyphae. (D) Necrotic retina. Note that the hyphae infiltrate predominantly the internal limiting membrane.