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CHRONIC ENDOPHTHALMITIS DUE TO PYRENOCHETA ROMEROI IN AN IMMUNOCOMPETENT HOST—A CASE REPORT FROM SOUTHERN INDIA

Babu, Kalpana DO, MRCOphth (Lon)*; Murthy, Praveen R. MS*; Prakash, Peralam Y. MSc, PhD; Kattige, Jyoti MS*; Rangaswamy, Sukanya MD; Murthy, Vinay R. MS*; Murthy, Krishna R. DO, MRCOphth (Lon)*

RETINAL Cases & Brief Reports: Summer 2014 - Volume 8 - Issue 3 - p 197–199
doi: 10.1097/ICB.0000000000000041
Case Report

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.

Endophthalmitis due to Pyrenochaeta romeroi has not been reported in literature (PubMed, Medline). The authors report an interesting case of P. romeroi causing chronic endophthalmitis in an immunocompetent woman. The negative smears, cultures, and polymerase chain reaction for bacteria and fungi in the initial aqueous taps, visualization of the flocculent mass in the pars plana and peripheral retina only after lensectomy, and the growth of a rare fungus on culture from this flocculent mass posed a significant diagnostic and therapeutic challenge.

*Department of Intraocular Inflammation and Vitreoretinal Services, Vittala International Institute of Ophthalmology and Prabha Eye Clinic and Research Center, Bangalore, India;

Department of Medical Mycology, Kasturba Medical College, Manipal, India; and

Department of Microbiology and Infection Control, Fortis Hospitals, Bangalore, India.

Reprint requests: Kalpana Babu, DO, MRCOphth (Lon), Prabha Eye clinic & Research center, 504, 40th Cross, Jayanagar, 8th block, Bangalore 560070, India; e-mail: kalpana@prabhaeyeclinic.com

None of the authors have any financial/conflicting interests to disclose.

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© 2014 by Ophthalmic Communications Society, Inc.