Exogenous cryptococcal endophthalmitis in an immunocompetent patient

Abstract

We describe a case of exogenous cryptococcal endophthalmitis without central nervous system (CNS) involvement or systemic infection in an immunocompetent patient. An 82-year-old male with hypertension, hyperlipidemia, type 2 diabetes mellitus, and primary open-angle glaucoma with a history of left eye trabeculectomy presented with 3 months of worsening left eye pain and redness. Vitreous cultures resulted as Cryptococcus, prompting treatment with intravitreal amphotericin and further investigation. Systemic workup was unrevealing for an endogenous source, CNS involvement, or immunocompromising conditions. He was treated with an aggressive regimen of systemic antifungals, leading to subjective improvements in clinical exam and in vision.

Keywords: Bleb-related endophthalmitis; Cryptococcus; endophthalmitis; fungal; glaucoma.

Figure 1

Anterior segment photograph of the left eye on presentation showing conjunctival injection and scleral thinning at the trabeculectomy site

Figure 2

B-scan of the left eye on presentation showing hyperechoic vitreous debris

Figure 3

Magnetic resonance imaging showing T2 prolongation involving the intraorbital segment of the left optic nerve which is compatible with optic neuritis secondary to infection