title: Intravenous fluconazole for bilateral endogenous Candida endophthalmitis.
abstract: OBJECTIVE
  To report a case of bilateral endogenous candida endophthalmitis treated with intravenous fluconazole.
  
  
  METHODS
  A 54-year-old man with poorly controlled diabetes presented with blurring of vision in both eyes, associated with eye pain for the past 2 months. Ocular examination revealed vision RE 4/60 ph 6/24, left eye (LE) 3/60. Anterior chamber examination showed 2+ anterior chamber cells in the LE. A streak of hypopyon was also noted in the LE. Both fundi showed presence of vitritis and white opacities. Proliferative diabetic retinopathy was present bilaterally. A diagnosis of bilateral endogenous endophthalmitis was made.
  
  
  RESULTS
  The patient was empirically treated with intravitreal vancomycin/ceftazidime on 3 consecutive days pending culture and sensitivity result. Blood and urine samples were negative for organisms. Vitreous samples were taken at the first intravitreal. The culture and sensitivity report of the vitreous sample was positive for candida albicans, which was sensitive to fluconazole. The patient was commenced on intravenous fluconazole 400  mg daily. The patient underwent core vitrectomy in the LE. Fluconazole was continued for 4 weeks, and he showed dramatic improvement with vision 6/12 in both eyes (OU) and endophthalmitis completely resolved.
  
  
  CONCLUSIONS
  There should be high index of suspicion of fungal endophthalmitis in patients with immune-compromised state even with no known septic foci.
authors.affiliation: Department of Ophthalmology, University of Malaya, Kuala Lumpur, Malaysia. thirusukan@yahoo.com
authors.forename: Thirupathy
authors.initials: T
authors.lastname: Annamalai
authors.forename: Kenneth Choong Sian
authors.initials: KC
authors.lastname: Fong
authors.forename: May May
authors.initials: MM
authors.lastname: Choo
mesh_terms: D000935:Antifungal Agents / Q000008:administration & dosage*; D002177:Candidiasis / Q000188:drug therapy*; D003930:Diabetic Retinopathy / Q000150:complications; D004334:Drug Administration Schedule; D009877:Endophthalmitis / Q000150:complications / Q000382:microbiology* / Q000601:surgery; D015725:Fluconazole / Q000008:administration & dosage*; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D014786:Vision Disorders / Q000209:etiology; D014821:Vitrectomy
chemical_list: D000935:Antifungal Agents; D015725:Fluconazole