Thermal therapy for Sporothrix endogenous endophthalmitis of the anterior segment

Abstract

Purpose: To report a case of Sporothrix shenkii endophthalmitis successfully treated with local thermal therapy after failure of conventional systemic and local antifungal therapy.

Observations: A 44-year-old female on long-term immunosuppressive therapy for extrapulmonary sarcoidosis presented with bilateral Sporothrix shenkii endophthalmitis. Despite prolonged systemic antifungal therapy, numerous intraocular antifungal injections, and surgical intervention with vitrectomy and lensectomy, her condition worsened with progressively increased fungal burden in the anterior chamber. At the patients request, interventional ocular procedures including intraocular injections were withdrawn and enucleation was considered secondary to pain and severe scleral thinning. Local thermal therapy was initiated as a palliative measure, supported by evidence for Sporothrix growth inhibition above 38.5 °C and efficacy with cutaneous Sporothrix. Initiation of ocular thermal therapy with a commercially available electronic heat mask was followed by a dramatic and durable improvement in pain and fungal burden.

Conclusions and importance: Thermal therapy may be an effective alternative for Sporothrix endophthalmitis affecting the anterior segment with lower risk for toxicity than intraocular injection of antimicrobial therapy.

Keywords: Endogenous endophthalmitis; Endophthalmitis; Heat therapy; Sporothrix endophthalmitis; Sporothrix shenkii; Thermal therapy.

Fig. 1

Active skin lesions of A: right hand and B: upper chest. C: Iris nodule right eye.

Fig. 2

A: Cataract formation and extensive anterior segment fungal debris prior to pars plana vitrectomy and lensectomy and prior to initiation of thermal therapy. B: After pars plana vitrectomy there was rapid development of a large anterior chamber fungal ball. C: Reduction in anterior chamber disease burden 1 month after initiation of thermal therapy. D: Complete resolution of anterior chamber disease after 3 months with thermal therapy.