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

Summary

An 18-year-old leukemia patient developed a serious fungal eye infection from Fusarium during cancer treatment. The infection spread through the bloodstream to both eyes, causing serious inflammation and vision loss. Doctors treated it with multiple antifungal medications injected directly into the eyes along with systemic medication, which controlled the infection but unfortunately the patient’s vision was significantly affected. This case highlights how rare but serious eye infections can occur in cancer patients with weakened immune systems.

Background

Disseminated fungal infections are a major challenge in onco-hematological patients, with Fusarium spp increasingly documented as a causative agent. Fusarium endophthalmitis via hematogenous spread is rare but serious in immunocompromised patients and requires prolonged systemic and intravitreal antifungal therapy.

Objective

To describe an unusual case of disseminated fusariosis complicated with endogenous fungal endophthalmitis in a pediatric patient with acute lymphoid leukemia in remission, highlighting the challenges of early diagnosis and management.

Results

Patient developed disseminated fusariosis with skin lesions, pulmonary involvement and bilateral endophthalmitis caused by Fusarium solani complex. Treatment with combined systemic antifungals (voriconazole and amphotericin B lipid complex) and 10 intravitreal voriconazole injections resulted in disease control and skin lesion regression, though patient retained only light perception vision bilaterally.

Conclusion

This case demonstrates successful management of endogenous Fusarium endophthalmitis without CNS impairment or eye enucleation through aggressive intraocular and systemic antifungal therapy. Early clinical suspicion, imaging and microbiological confirmation are critical for diagnosis of this uncommon but serious complication in immunocompromised patients.
  • Published in:Medical Mycology Case Reports,
  • Study Type:Case Report,
  • Source: PMID: 41140300, DOI: 10.1016/j.mmcr.2025.100742
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