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Ophthalmic Images |

Enhanced Depth Imaging Optical Coherence Tomography of Endogenous Fungal Chorioretinitis Online Only

Murtaza K. Adam, MD1; Ehsan Rahimy, MD1
[+] Author Affiliations
1Retina Service, Wills Eye Hospital, Philadelphia, Pennsylvania
JAMA Ophthalmol. 2015;133(11):e151931. doi:10.1001/jamaophthalmol.2015.1931.
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This case report describes findings in a patient with endogenous fungal chorioretinitis.

A man in his mid-30s with a history of chronic alcohol-related pancreatitis complicated by pseudocyst formation presented with a 2-week history of fever and floaters in both eyes. The patient was receiving total parenteral nutrition via a percutaneous intravenous central catheter during the previous 3 months. Blood cultures obtained at admission grew Candida albicans and intravenous treatment was initiated with micafungin sodium and fluconazole. Echocardiography revealed a large right atrial vegetation and computed tomography of the chest demonstrated multiple septic emboli. The patient’s percutaneous intravenous central catheter was removed and he underwent sternotomy and excision of his right atrial vegetation. At presentation, visual acuity was 20/25 OU. Dilated ophthalmoscopic examination demonstrated multiple white chorioretinal lesions in the posterior pole of both eyes without vitreal extension and showed rare hemorrhages with Roth spots, which remained stable throughout the patient’s 2-week hospital course. Fundus photographs and enhanced depth imaging optical coherence tomography were used to document these findings (Figure). The patient was lost to follow-up following discharge.

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Color fundus photograph (A) and enhanced depth imaging optical coherence tomography (B) of the left eye in a patient with bilateral endogenous Candida albicans fungal chorioretinitis, demonstrating choroidal hyperreflectivity and a subretinal pigment epithelial infiltrate with retinal infiltration. The green line in A corresponds to the enhanced depth imaging optical coherence tomographic scan cross section in B.

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