A 34-year-old man with a history of intravenous drug use and hepatitis C infection presented to the ophthalmology clinic with a 1-week history of pain and decreased vision in his right eye. The visual acuity was 20/400 in the right eye and 20/20 in the left eye. Slit-lamp examination of the right eye showed conjunctival injection and inflammation in the anterior chamber. Indirect ophthalmoscopy showed vitreous haze with yellow-white lesions on the retina and optic nerve. Following workup, surgery was performed and a white mass measuring 4 mm by 3 mm by 1 mm was seen adherent to the optic nerve. What is the most likely diagnosis/etiology?
- Retinoblastoma
Answer
Right answer is 4
Explanation
Fungal endophthalmitis had been suspected following slit-lamp examination in this patient. Despite a course of treatment with oral and intravitreal voriconazole, the vitreous lesions persisted and a vitrectomy was performed with the findings above. Pathological analysis of the mass revealed a necrotizing granuloma with fungal yeast forms on Gomori methenamine silver staining, a finding consistent with the candida species. After surgery, the visual acuity in the patient’s right eye improved to 20/30, and he completed 6 weeks of oral voriconazole treatment. At the 6-month follow-up visit, his vision was stable and there was no evidence of recurrence.
ref nejm.org
