Fungal Endophthalmitis

Fundus photograph of a 53-year-old woman who presented with blurred vision and floaters for several months. She had a history of an undiagnosed autoimmune disease and had been treated with prednisone for the past 14 years, with failed trials of numerous immune modulating medications. Examination showed vitreous cells and debris with puff balls in the left eye. There were preretinal white infiltrates in the periphery (green arrows). She had a history of numerous courses with IV antibiotics; the long indwelling intravenous lines may have been the probable source of the fungal infection. She underwent vitrectomy for sampling and culture of the vitreous as well as debulking of the infectious load together with intravitreal amphotericin B 5 micrograms and oral voriconazole 200 mg twice daily.