title: Exophiala werneckii endophthalmitis following cartaract surgery in an immunocompetent individual.
abstract: A case of infectious endophthalmitis caused by the saprophyte Exophiala werneckii is reported. This has not been recognized as a pathogen for ocular infections previously. The infection followed uncomplicated cataract surgery involving phacoemulsification and IOL implant. Clinical presentation was that of an indolent endophthalmitis with relatively acute onset. Pars plana vitrectomy, fungal stains, and culture established the diagnosis. Initial management consisted of empirical intravitreal injection of vancomycin, ceftazidime, and amphotericin B. Treatment was supplemented with a 3-week course of systemic fluconazole and topical therapy with natamycin, atropine, ciprofloxacin, and diclofenac. The visual acuity returned to 20/20-2 with no recurrence of infection. The source of the infection could not be determined. Fungal endophthalmitis has to be considered as a rare, though important, complication following ophthalmic surgery. Specific fungal stains and cultures are helpful for establishing the diagnosis early in the course of disease. E werneckii should be considered in the differential diagnosis of fungal endophthalmitis.
authors.affiliation: University of Utah Department of Ophthalmology, Salt Lake City, USA.
authors.forename: C E
authors.initials: CE
authors.lastname: Huber
authors.forename: T
authors.initials: T
authors.lastname: LaBerge
authors.forename: T
authors.initials: T
authors.lastname: Schwiesow
authors.forename: K
authors.initials: K
authors.lastname: Carroll
authors.forename: P S
authors.initials: PS
authors.lastname: Bernstein
authors.forename: N
authors.initials: N
authors.lastname: Mamalis
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents; D003937:Diagnosis, Differential; D004359:Drug Therapy, Combination / Q000627:therapeutic use; D009877:Endophthalmitis / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D005093:Exophiala / Q000302:isolation & purification*; D015821:Eye Infections, Fungal / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D005260:Female; D006801:Humans; D019654:Lens Implantation, Intraocular / Q000009:adverse effects*; D009181:Mycoses / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D018918:Phacoemulsification / Q000009:adverse effects*; D012086:Reoperation; D013530:Surgical Wound Infection / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D014792:Visual Acuity; D014821:Vitrectomy; D014822:Vitreous Body / Q000382:microbiology / Q000601:surgery
chemical_list: D000900:Anti-Bacterial Agents