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

Summary

An 18-year-old cancer patient undergoing chemotherapy developed a serious infection with Fusarium, a mold that spread throughout his body including to his eyes, causing vision problems. Doctors treated him with a combination of antifungal medications given both systemically and directly injected into his eyes. Although the infection was controlled and his life was saved, he lost most of his vision in both eyes but was able to keep them rather than requiring removal.

Background

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

Objective

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

Results

The patient developed Fusarium solani complex infection with multisystemic involvement. Despite negative initial vitreous culture, bilateral endophthalmitis was confirmed by imaging and subsequent vitreous biopsy after 17 days of antifungal therapy. Treatment with systemic voriconazole and amphotericin B lipid complex combined with 10 intravitreal voriconazole injections resulted in disease control and skin lesion regression, though visual acuity was reduced to light perception.

Conclusion

This case demonstrates successful management of endogenous Fusarium endophthalmitis with combined systemic and intravitreal antifungal therapy without requiring enucleation. Early clinical suspicion and diagnostic imaging are crucial for identifying this serious complication in immunocompromised patients with 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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