J Korean Ophthalmol Soc.  2018 Mar;59(3):282-287. 10.3341/jkos.2018.59.3.282.

A Case of Fungal Endophthalmitis after Having Received Extraction of Wisdom Tooth in Healthy Woman

• Lee M
• Choi EY
• Lee SC
• Kim M

• KMID: 2406964
• DOI: http://doi.org/10.3341/jkos.2018.59.3.282

Abstract

PURPOSE
To report a case of candida endogenous endophthalmitis in healthy women who had received extraction of wisdom tooth.
CASE SUMMARY
A 65-year-old medically healthy woman who had received extraction of wisdom tooth two weeks ago, presented with floater symptoms in her left eye. Best-corrected visual acuity was 20/40 and intraocular pressure was 17 mmHg in her left eye. Inflammatory cells were found in the anterior chamber and vitreous. Fluorescein angiography showed multiple hypofluorescence without vascular leakage. With provisional diagnosis of intermediate uveitis, she was prescribed oral steroid for two weeks. After that, inflammatory cells in anterior chamber was reduced but vitreous imflammatory cell was increased and fundus examination detected newly developed infiltrated lesion at superotemporal area. The patient was presumed to have fungal endophthalmitis and immediate intravitreal voriconazole injection was performed. Three days after intravitreal voriconazole injection, diagnostic vitrectomy and intravitreal voriconazole injection were performed. Vitreous cultures revealed the growth of Candida albicans. Despite the treatment, inflammatory response in anterior chamber and vitreous rapidly increased and visual acuity was decreased to hand movement. We changed anti-fungal agent, voriconazole to Amphotericin B. Additional three-time intravitreal injection was done and therapeutic vitrectomy with oil injection were performed. After treatment, the patient's fundus markedly improved and inflammatory response was decreased.
CONCLUSIONS
This case report shows candida endophthalmitis in healthy woman who had received extraction of wisdom tooth. So to diagnose endophthalmitis, patient's medical history should carefully be checked including dental care history who presented with vitreous inflammation and inflammatory infiltrated lesion at fundus.

Keyword

Candida endophthalmitis; Diagnostic vitrectomy; Endogenous endophthalmitis

MeSH Terms

Aged
Amphotericin B
Anterior Chamber
Candida
Candida albicans
Dental Care
Diagnosis
Endophthalmitis*
Female
Fluorescein Angiography
Hand
Humans
Inflammation
Intraocular Pressure
Intravitreal Injections
Molar, Third*
Uveitis, Intermediate
Visual Acuity
Vitrectomy
Voriconazole
Amphotericin B
Voriconazole

Figure

• 

  Figure 1. A 65-year-old woman with no previous medical history presented with floater symptoms of the left eye 2 weeks after having received extraction of wisdom tooth. (A) Fundus examination showed multiple snowball at inferior vitreous with one disc diameter sized yellowish preretinal infiltrated lesion at superonasal (white arrowheads). (B) Optical coherence tomography showed epiretinal membrane at macula. (C) Fluorescein angiography showed multiple hypofluorescence without vascular leakage.

• 

  Figure 2. Slit photo and fundus photo, after steroid treatment. After 2 weeks of oral steroid treatment (A) vitiritis was aggravated and (B) newly appeared retinal infiltration at superotemporal was noted (red arrowheads). The size of infiltrated lesion at superonasal increased (white arrowheads). Under the impression of fungal endophthalmitis, intravitreal voriconazole injection was done. On the follow up after voriconazole injection, retinal infiltration increased and vitritis aggravated. (C) Anterior chamber hypopyon and severe vitritis (green line and white arrowheads) was noted. Under the impression of candidal endophthalmitis, therapeutic vitrectomy was performed. (D) Severe vitreous opacity and pus was noted (yellow arrowheads). Extensive vascular sheathing (green arrowheads) and retinal hemorrhage was also noted (blue arrowheads).

• 

  Figure 3. Images of post therapeutic vitrectomy with silicone oil injection. After having received multiple intravitreal voriconazole injections for 2 weeks, (A) anterior chamber reaction and vitritis was completely resolved. Her best-corrected visual acuity recovered to 0.1 at post operative 2 weeks. (B) Fundus examination showed clearly regressed retinal infiltrations and (C) optical coherence tomography showed epiretinal membrane with small hyperreflective membrane at outer retinal layer.

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