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Endophthalmitis associated with Purpureocillium lilacinum during infliximab treatment for surgically induced necrotizing scleritis, successfully treated with 27-gauge vitrectomy

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Abstract

Purpose

To report a case of endophthalmitis associated with Purpureocillium lilacinum (P. lilacinum) during infliximab treatment for surgically induced necrotizing scleritis, successfully treated with 27-gauge vitrectomy.

Methods

A single case report.

Results

A 71-year-old man who had undergone immunosuppressive therapy, including infliximab, for surgically induced necrotizing scleritis (SINS) in his left eye complained of visual disturbance and eye pain in the eye. He had a past history of surgery for recurrent pterygium: pterygium excision, amnion transplantation with mitomycin C and limbal transplantation. Visual acuity in the left eye was counting fingers at 30 cm, and intraocular pressure was 3.0 mmHg. Slit-lamp examination revealed the presence of anterior chamber cells (3+), and a B-mode ultrasound scan showed a vitreous opacity. We made a diagnosis of endophthalmitis and performed 27-gauge microincision vitrectomy surgery (27GMIVS) with antibiotic perfusion of ceftazidime, vancomycin and voriconazole. Intraoperative findings included a fungus-like ball-shaped opacity in the vitreous, and a close-to-normal retinal appearance. A vitreous body culture identified the presence of P. lilacinum. After 2 months of antibacterial and antifungal therapy, inflammation decreased and visual acuity recovered to 20/100.

Conclusions

This is the first report of a case of endophthalmitis associated with P. lilacinum during infliximab treatment for SINS. Scleral thinning due to necrotizing scleritis, especially during immunosuppressive therapy, is a risk factor for endophthalmitis. We found that 27GMIVS was a useful strategy for such a challenging clinical situation.

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Authors and Affiliations

  1. Department of Ophthalmology, Tohoku University Graduate School of Medicine, Sendai, Japan

    Masaaki Yoshida, Shunji Yokokura, Hiroshi Kunikata, Naoko Takada, Kazuichi Maruyama & Toru Nakazawa

  2. Department of Retinal Disease Control, Tohoku University Graduate School of Medicine, Sendai, Japan

    Hiroshi Kunikata & Toru Nakazawa

  3. Department of Advanced Ophthalmic Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan

    Toru Nakazawa

  4. Department of Ophthalmic Imaging and Information Analytics, Tohoku University Graduate School of Medicine, Sendai, Japan

    Toru Nakazawa

  5. Department of Laboratory Medicine, Tohoku University Hospital, Sendai, Japan

    Masahiro Toyokawa & Kazushi Kashio

  6. Department of Infection Control and Laboratory Diagnostics, Tohoku University Graduate School of Medicine, Sendai, Japan

    Mitsuo Kaku

Authors
  1. Masaaki Yoshida
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  2. Shunji Yokokura
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  3. Hiroshi Kunikata
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  4. Naoko Takada
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  5. Kazuichi Maruyama
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  6. Masahiro Toyokawa
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  7. Kazushi Kashio
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  8. Mitsuo Kaku
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  9. Toru Nakazawa
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Corresponding author

Correspondence to Shunji Yokokura.

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The authors declare that they have no conflict of interest.

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The case presentation conforms to the principles of the Declaration of Helsinki.

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Yoshida, M., Yokokura, S., Kunikata, H. et al. Endophthalmitis associated with Purpureocillium lilacinum during infliximab treatment for surgically induced necrotizing scleritis, successfully treated with 27-gauge vitrectomy. Int Ophthalmol 38, 841–847 (2018). https://doi.org/10.1007/s10792-017-0532-4

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  • DOI: https://doi.org/10.1007/s10792-017-0532-4

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