Título / Title

ENDOPHTHALMITIS IN A PATIENT WITH ACUTE MYELOID LEUKEMIA (AML) AND SYSTEMIC FUSARIUM CO-INFECTION: A CASE REPORT.

Introdução / Purpose

A 48-year-old male patient diagnosed with AML presented a systemic Fusarium sp. infection that underwent treatment with intravenous (IV) Voriconazole and Amphotericin B started to complain of visual loss in OD.

Material e Método / Methods

This is a retrospective case review study,

Resultados / Results

History of retinal detachment in OD treated with retinopexy with scleral introflexion in 2009. Visual acuity (VA) OD was hand motion. Anterior segment examination: conjunctival hyperemia, hypopyon, pupillary membrane. Fundus examination: vitreous turbidity that compromised visibility. A B-scan ultrasound revealed dense, hyper-reflective echoes in the vitreous cavity suggesting intense inflammatory/infectious process. Pars Plana Vitrectomy (PPV) was performed along with IVI of Vancomycin, Ceftazidime and Amphotericin B. Intraoperatively: diffuse vitreous opacity, pale optic disc, multiple intraretinal hemorrhagic foci, diffuse retinal necrosis, and a nodular yellowish dense area of vitreous. In the 1st post-op (PO) VA was counting fingers. On the 3rd PO, VA decreased to hand motion. On exam: anterior chamber reaction 4+/4+ and fundus examination revealed recurrence of a yellowish mass with poorly defined borders and a size of 3 disc diameters (DD) in the vitreous (figure 1). IVI of Amphotericin B was indicated and led to regressions of the yellowish mass (1 DD) along well-defined edges (figure 2). Patient continued on IV Amphotericin B and on eye drops (1% prednisolone acetate and gatifloxacin). Vitreous cultures were not conclusive. Endophthalmitis was considered treated and he followed to an uneventful bone marrow transplant.

Discussão e Conclusões / Conclusion

Endogenous endophthalmitis (EE) secondary to hematogenous spread is a rare event. Malignant disease was present in 21.4%-69.7% of fungal EE. It's frequently caused by Candida and Aspergillus , and hardly, Fusarium. Invasive fusariosis affects patients with high-risk hematologic disease, especially AML. The treatment of EE encompasses IVI and PPV. Multiprofessional follow-up is essential

Palavras Chave

Endophthalmitis, Fusarium, vitrectomy, leukemia

Area

SURGICAL RETINA