Treatment of bilateral candidal endophthalmitis with intravenous caspofungin.
OBJECTIVE
Fungal resistances to drugs are increasing. Caspofungin is a new antifungal agent effective in the treatment of invasive candidiasis. We report a case of candidal endophthalmitis that responded adequately to caspofungin.


METHODS
A 24-year-old man with acute myeloid leukemia presented with vision loss in both eyes. Visual acuity was 20/50 in the right eye and counting fingers in the left eye. Fundus examination revealed multiple, premacular, vitreous, pearl stringshaped condensations in the right eye and a subretinal abscess in the left eye. Treatment with 50 mg of intravenous caspofungin once daily was started.


RESULTS
After 1 month, inflammation in both eyes had decreased, although the left eye developed macular scarring. Medication at discharge was intravenous caspofungin once daily for another 6 weeks. Nine months after presentation, the patient had residual vitreous condensations in the premacular region of the right eye with visual acuity of 20/25 and severe macular scarring in the left eye with visual acuity of 20/100.


CONCLUSIONS
This case adds support for the use of caspofungin as monotherapy for candidal endophthalmitis. Further studies are necessary to determine treatment options for the new antifungal agents.
From Ramón y Cajal University Hospital, Madrid, Spain.
Inés
I
Contreras
Carolina
C
Arruabarrena
Marta S
MS
Figueroa