Candida endogenous endophthalmitis

Objective: To report an uncommon case of bilateral candida endogenous endophthalmitis that presented as a diagnostic dilemma because of negative vitreous cultures. Methods: This is a case report. Results: A 47-year-old Indian with poorly controlled type 2 diabetes mellitus was referred with complaints of blurred vision for a week. Visual acuity was bilateral hand movement. Examination revealed bilateral panuveitis, with fine keratic precipitates and pigment deposits on the lens surface. Posterior-segment findings included severe vitritis, vitreous “cotton balls,” multifocal retinal exudates, and fluffy chorioretinitis. The patient was treated with oral fluconazole and intravitreal amphotericin with no clinical improvement. A pars plana vitrectomy was performed resulting in improvement in vision. Conclusion: Panuveitis in patients with uncontrolled diabetes mellitus should raise the suspicion of endogenous endophthalmitis with Candida being the most important differential. Blood and vitreous cultures for fungi will increase the microbiological yield. Prompt treatment with suitable intravitreal and systemic antifungal agents plus vitrectomy may prevent blindness.