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Endogenous Endophthalmitis: An underestimated serious complication in patients with disseminated fusariosis

Summary

An 18-year-old boy with acute leukemia developed a serious fungal infection caused by Fusarium mold that spread throughout his body, including to both eyes. Despite receiving intensive antifungal medications injected directly into his eyes along with systemic treatment, he lost his vision. However, through aggressive combined therapy, doctors were able to save both eyes and continue his cancer treatment successfully.

Background

Disseminated fungal infections are a significant challenge in onco-hematological patients. While Aspergillus is the most common mold pathogen, Fusarium infections are increasingly documented, particularly in Brazil. Fusarium endophthalmitis is rare but represents a serious complication in immunocompromised patients.

Objective

To describe an unusual case of a patient with high-risk acute lymphoid leukemia in complete remission who developed invasive and disseminated fusariosis complicated by fungal endophthalmitis.

Results

Patient developed disseminated fusariosis with skin lesions, pulmonary involvement, and bilateral endophthalmitis caused by Fusarium solani complex. Treatment included systemic antifungals (voriconazole and amphotericin B lipid complex) combined with 10 intravitreal voriconazole injections. Visual acuity was reduced to light perception but both eyes were retained.

Conclusion

This case demonstrates successful treatment of endogenous Fusarium endophthalmitis with combined intraocular and systemic antifungal therapy without requiring enucleation. Early detection through clinical suspicion and imaging is crucial for managing this rare but serious complication in disseminated fusariosis.
  • Published in:Medical Mycology Case Reports,
  • Study Type:Case Report,
  • Source: PMID: 41140300, DOI: 10.1016/j.mmcr.2025.100742
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