Bialasiewicz A. A.

Universitäts-Augenklinik Eppendorf, Hamburg; Department of Ophthalmology, SQUH University of Oman, Al Khod/Muscat

Objective: Alternaria alternata is a ubiquitous fungus, which may appear in postoperative and metastatic endophthalmitis. This case report shows the sometimes difficult differential diagnosis to be made.
Case report: An 86 year old patient operated on his OD 4 years previously (VA cc20/20) had received surgery for a a rectum carcinoma includgin an anus praeter. A positive Seidel test had prevailed for more than 3 days after cataract surgery on his left eye. 5 months later he presented with fibrin, a hypopyon 1mm and vitreous infiltration (fundus no details) with no hint at a preceding trauma for vitrectomy. VA OS sc20/200, IOD 24 mmHg, slight leukocytosis 10.8/nl, ESR 48/85mm.
Results: Intraoperatively a slightly inflamed anterior segment and a moderate peripheral vitreous infiltration (180° in the lower circumference) sheathed vessels, large grey chorioretinal infiltrates and pre- and intraretinal hemorrhages in the central fundus were seen. Additionally, a preretinal not vascularized peripapillary membrane was bridging towards the central infiltrate. The vitreous aspirate showed fungi classifeid as Alternaria alternata. The intravitreal (vancomycin), local (ofloxacin) and systemic (ciprofloxacin+imipenem-cilastatin) antibacterial treatment was changed to amphotericin B 15mg combined with ancotil 3x2.5g/d and the eye was cured without recurrences, the ESR was normalized to 10/26mm. A search for further fungal spread was uneventful.
Conclusions: The differential diagnosis of metastatic and postoperative endophthalmitis depends on the intraoperative morphologic classification of the main inflammatory lesions, systemic inflammatory parameters, the probability of specific microbes, and the patients' risk profile concerning compromising diseases.

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