title: Post-operative endophthalmitis caused by Acremonium falciforme with orbital and extra-orbital involvement following combined cataract and glaucoma surgery: a case report.
abstract: BACKGROUND
  In this report, we describe an unusual case of post-operative Acremonium falciforme endophthalmitis with orbital and extra-orbital involvement following combined cataract and glaucoma surgery.
  
  
  METHODS
  A 68-year-old Caucasian man with glaucoma presented with endophthalmitis characterized by pain, redness and impaired vision in the left eye fifteen days after combined cataract and filtering surgery. He subsequently underwent a pars plana vitrectomy, with vitreous sampling, silicone oil placement and intra-vitreal injection of antibiotics, but only after a second vitrectomy we identified Acremonium falciforme as the causative agent for the endophthalmitis. An antifungal systemic and topical therapy was started, but meanwhile the infection extended to orbital and peri-orbital tissues. Following these procedures, even if the eye went slowly in phthisis, we were able to limit the further extension and circumscribe the orbital and extra-orbital involvement.
  
  
  CONCLUSIONS
  To our knowledge, this report is the first describe Acremonium falciforme endophthalmitis with orbital and extra-orbital involvement, following anterior segment combined surgery. Ophthalmologists and physicians should be aware of the extension risk of a fungal panophthalmitis, but also to potentially serious side effects related to systemic therapy.
authors.affiliation: Department of Surgical and Biomedical Sciences, University of Perugia, Ospedale S Maria della Misericordia, Sant'Andrea delle Fratte, Piazza Menghini 1, 06156 Perugia, Italy. carlo.cagini@unipg.it.
authors.forename: Carlo
authors.initials: C
authors.lastname: Cagini
authors.forename: Alessia
authors.initials: A
authors.lastname: Iannone
authors.forename: Tito
authors.initials: T
authors.lastname: Fiore
authors.forename: Marco
authors.initials: M
authors.lastname: Lupidi
authors.forename: Leopoldo
authors.initials: L
authors.lastname: Spadea
mesh_terms: D000164:Acremonium; D000368:Aged; D000935:Antifungal Agents / Q000008:administration & dosage / Q000627:therapeutic use; D002387:Cataract Extraction / Q000009:adverse effects* / Q000379:methods; D009877:Endophthalmitis / Q000175:diagnosis / Q000209:etiology* / Q000382:microbiology; D015821:Eye Infections, Fungal / Q000175:diagnosis / Q000209:etiology* / Q000382:microbiology; D018463:Filtering Surgery / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D058449:Intravitreal Injections; D008297:Male; D009915:Orbit / Q000382:microbiology
chemical_list: D000935:Antifungal Agents