Search

PURPOSE: Endophthalmitis due to Pyrenochaeta romeroi has not been reported in literature (PubMed, Medline). We report an interesting case of P. romeroi causing chronic endophthalmitis in an immunocompetent lady.METHODS:Retrospective interventional case report. A 25-year-old immunocompetent lady presented with pain and redness in the left eye of 1-month duration. Her best-corrected visual acuity was 6/6 and 6/18 in the right and the left eyes, respectively. Slit-lamp examination of the left eye showed a corneal stromal scar, fibrinlike material in the anterior chamber, few retrolental cells, and normal fundus examination. RESULTS:Aqueous taps on two occasions were negative for bacteria and fungi on routine smear, culture, and nested polymerase chain reaction. As inflammation recurred despite intravitreal voriconazole and amikacin injections, a lensectomy with vitrectomy was done. During vitrectomy, dense flocculent material was seen in the pars plana with only scleral indentation. The flocculent material grew a rare filamentous fungus called P. romeroi. The left eye underwent retinal detachment surgery with silicone oil insertion for a giant retinal tear at 2 months of follow-up. At 6 months of follow-up, her vision in the left eye was stable at 6/24 (Snellen) with no ocular inflammation.CONCLUSION:P. romeroi may need to be added in the list of rare fungi, which cause chronic endophthalmitis.

Purpose To report an interesting ocular finding and course of bilateral arteritis with cytomegalovirus retinitis in a patient infected with the human immunodeficiency virus (HIV). Methods Retrospective single case report. Results A 39-year-old HIV-positive man on highly active antiretroviral therapy presented with a history of diminution of vision in both eyes of 1-month duration. Fundus examination showed vitritis, sheathing, and a cordlike appearance of the arteries with veins unaffected in both eyes. A patch of cystomegalovirus retinitis was noted temporally in the right eye. Fluorescein angiography showed gross areas of capillary nonperfusion in both eyes. Polymerase chain reaction of the aqueous tap was positive for cytomegalovirus in both eyes. Despite aggressive treatment with intravitreal ganciclovir followed by a course of intravenous ganciclovir, the right eye progressed to neovascularization, vitreous hemorrhage, neovascular glaucoma, and no perception of light. Segmentation and recanalization of arteries were noted in the left eye. Immune recovery uveitis developed in the left eye after 2 months and was treated with oral steroids and intravenous ganciclovir followed by a maintenance dose of valganciclovir. At 3 years follow up, his vision and ocular condition in the left eye is stable. Conclusion An interesting finding of bilateral arteritis with cystomegalovirus retinitis in an HIV-positive patient is reported. The arteritis did not respond very well to intravitreal ganciclovir and required a course of intravenous ganciclovir. Early treatment with intravenous ganciclovir and laser photocoagulation in such cases may reduce visual morbidity.