C. Auris Costs Man an Eye

Immunocompromised patients with Candida auris infection could be at risk for panophthalmitis, a blinding ocular condition, according to a case study.

An HIV-positive patient recently diagnosed with syphilis, who also had C. auris infection, experienced sudden vision loss, despite lacking history of trauma, surgery, or corneal ulceration, reported Vinayak Shenoy, DO, of Lenox Hill Hospital in New York City, and colleagues.

This was suggestive of endogenous panophthalmitis, the authors wrote in a case report in the Annals of Internal Medicine.

They noted only one other previous report of a serious eye infection caused by C. auris — a 2018 study about the emergence of C. auris in Kuwait and the Middle East. They added that bloodstream, wound, urinary, and respiratory tract infections had previously been linked to nosocomial C. auris outbreaks worldwide.

Panophthalmitis is inflammation of all parts of the eye, which can lead to serious visual complications, such as no light perception and scleral abscess. The condition has been linked to infectious causes, such as Pseudomonas aeruginosa and Clostridium species, as well as certain fungi.

Researchers said their objective was to “increase clinicians’ awareness that C. auris may cause panophthalmitis,” and they specifically noted that immunosuppression is a known risk factor for endogenous panophthalmitis.

“Our case confirms that panophthalmitis with C. auris may occur in an immunocompromised patient without a history of trauma and that the infection may have a fulminant course, resulting in loss of vision and structural integrity of the eye,” they wrote.

They detailed the case of a man, age 30, with vision loss, who presented in the emergency department with a closed right eye with “periorbital swelling, proptosis, chemosis, and purulent discharge.” In addition, his right pupil was fixed and nonreactive to light. A CT scan suggested panophthalmitis with orbital cellulitis. The authors noted that he also had HIV infection and was recently diagnosed with syphilis.

The man was admitted and treated with a variety of intravitreal antibiotics for bacterial coverage, fungal coverage, and to cover both herpes simplex virus and cytomegalovirus. He then underwent enucleation (removal of the eye leaving the muscles and orbital contacts intact) and orbital washout with vancomycin and ceftazidime. His vitreous cultures grew out Pseudomonas aeruginosa and “yeast-like cells” later identified to be C. auris.

A course of treatment with intravenous micafungin, which can treat infections caused by Candida fungus, improved the patient’s symptoms, and he was discharged with HIV medication, intravenous micafungin, as well as oral metronidazole and ciprofloxacin before being lost to follow-up, the authors said.