Scedosporium endophthalmitis: two fatal disseminated cases of Scedosporium infection presenting with endophthalmitis.
The incidence of disseminated infection with Scedosporium species is increasing in patients with haematological malignancy. Two fatal cases are reported of patients with acute myeloid leukaemia and neutropenia who presented with Scedosporium endophthalmitis. Diagnosis of fungal infection was delayed as blood and vitreous cultures were positive only after 3 days in patient 1 and blood culture was positive at 7 days in patient 2. Despite antifungal therapy with amphotericin B and additional fluconazole in patient 2, both patients died of overwhelming fungal septicaemia. Post-mortem examination of the right globe in patient 1 showed haemorrhagic necrotizing chorioretinitis with numerous fungal hyphae in choroidal vessels, choroid, retina and vitreous. Scedosporium species are often resistant to conventional antifungal therapy including amphotericin B. Diagnosis is difficult and mortality in disseminated infection is high.
McKelvie
P A
PA
Department of Anatomical Pathology, St Vincent's Hospital, Fitzroy, Victoria, Australia. mckelvpa@svhm.org.au
Wong
E Y
EY
Chow
L P
LP
Hall
A J
AJ
D000208:Acute Disease; D000328:Adult; D000666:Amphotericin B / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D009877:Endophthalmitis / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D015821:Eye Infections, Fungal / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D017809:Fatal Outcome; D005260:Female; D015725:Fluconazole / Q000627:therapeutic use; D016469:Fungemia / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology; D006801:Humans; D007951:Leukemia, Myeloid / Q000382:microbiology; D008297:Male; D008875:Middle Aged; D008271:Mycetoma / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D009503:Neutropenia / Q000382:microbiology; D021681:Scedosporium / Q000302:isolation & purification*
D000935:Antifungal Agents; D000666:Amphotericin B; D015725:Fluconazole