Candida auris Tied to Vision Loss in Case Report

Jennifer Garcia

September 09, 2019

Infection with Candida auris likely led to panophthalmitis and vision loss in an immune compromised patient, according to a case report published online today in the Annals of Internal Medicine.

Vinayak Shenoy, DO, and colleagues at Lenox Hill Hospital in New York City, observe that panophthalmitis caused by C auris has only been reported in one prior case. However, C auris has been associated with nosocomial outbreaks and should be considered as an etiologic agent for panophthalmitis or sudden vision loss without trauma, particularly in patients with compromised immunity.

The 30-year-old patient, who had a history of HIV infection and a recent diagnosis of syphilis, presented to the emergency department with acute vision loss in the right eye. The patient was tachycardic but afebrile and doctors noted the presence of periorbital swelling, proptosis (protrusion of the eyeball), chemosis (conjunctival swelling), and purulent discharge from the eye.

Initial blood and urine cultures were negative for bacterial growth and the CD4 count was noted to be decreased at 53 x 109 cells/L (normal range, 489 to 1457 x 109 cells/L). CT scan was suggestive of panophthalmitis with orbital cellulitis.

Shenoy and colleagues admitted the patient for intravitreal antibiotic and antifungal injections, as well as intravenous antibiotic, antifungal, and antiviral therapy.

Vitreous cultures documented infection with Pseudomonas aeruginosa and yeast-like cells. Based on the possibility of cavernous sinus thrombosis noted on MRI, enucleation was performed to prevent further spread of the infection.

The yeast-like cells were ultimately determined to be C auris and the patient continued to improve with intravenous micafungin therapy, as well as an appropriate prophylaxis regimen for his HIV infection and oral antibiotics. The patient was subsequently lost to follow-up.

"Our case confirms that panophthalmitis with C auris may occur in an immunocompromised patient without a history of trauma and that the infection may have a fulminant course, resulting in loss of vision and structural integrity of the eye," Shenoy and colleagues conclude.

No funding was provided for this case report. The authors have disclosed no relevant financial relationships.

Ann Intern Med.  Published online September 9, 2019. Abstract

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