Intravitreal Voriconazole for the Treatment of Cryptococcus neoformans Endogenous Endophthalmitis

Abstract

Background: Cryptococcus neoformans is an encapsulated yeast that can cause fungemia and, in rare instances, lead to endogenous fungal endophthalmitis. No standard of care has been established to treat fungal endophthalmitis when systemic antifungal treatment fails to resolve the intraocular infection. Intravitreal voriconazole has been used for the treatment of fungal endophthalmitis caused by a broad range of fungal pathogens, and a limited number of reports have shown the efficacy of using intravitreal voriconazole for C neoformans endophthalmitis. We report a case of endogenous fungal endophthalmitis caused by C neoformans that was responsive to intravitreal voriconazole. Case Report: A previously healthy 57-year-old male diagnosed with primary neuroendocrine lung tumor developed endogenous endophthalmitis from C neoformans. The endophthalmitis was resistant to intravenous amphotericin B treatment but was responsive to intravenous fluconazole in one eye and was apparently more responsive to intravitreal voriconazole in the other eye. Conclusion: Intravitreal voriconazole should be considered for the treatment of cryptococcal endophthalmitis.

Keywords: Cryptococcus; Cryptococcus neoformans; endophthalmitis; eye infections–fungal; intravitreal injections; voriconazole.

Figure 1.

(A) Fundus photograph of the left eye from the initial dilated examination demonstrates a macular lesion with overlying vitritis. (B) Fundus photograph 4 weeks after initial evaluation shows regression of lesion.

Figure 2.

Fundus photographs of the left eye from the initial evaluation show a peripapillary lesion (A) with white chorioretinal infiltrates with vitritis (B and C). The peripapillary lesion showed worsening vitritis indicating progression at 1 week (D). Vitritis and chorioretinal infiltrates showed regression at the subsequent 2-week (E) and 4-week visits (F).

Figure 3.

Fundus photograph of the right eye 1 week after treatment (A) demonstrates a large chorioretinal infiltrate with overlying vitritis. The lesion responded well to treatment with a markedly regressed appearance at 2-week follow-up (B).