Candida albicans scleral abscess in a HIV-positive patient and its successful resolution with antifungal therapy—a first case report

BACKGROUND: Fungal infection of the sclera is very rare. No case of fungal scleral abscess in a HIV-positive patient has been reported. We report a case of scleral abscess caused by Candida albicans and its successful resolution following antifungal therapy in a HIV-positive patient. FINDINGS: A 57-year-old diabetic Asian (Indian) who was on HAART for the last 10 years presented with 2 weeks history of redness in his right eye. Examination revealed localised scleral inflammation with central ulceration in the inferior quadrant of the right eye. Initially, the ulcer scrapings revealed no microbial organism. Progression of ulcer although on empirical antibiotic therapy required repeat scrapings which showed C. albicans species in culture sensitive to amphotericin and natamycin. Aggressive topical and systemic antifungals resulted in dramatic and complete healing of the ulcer in 3 weeks. Vision was well maintained at 20/30 throughout the treatment course and the fundus remained normal. CONCLUSIONS: This is the first ever case of fungal scleral abscess in an HIV patient to be reported emphasising there is a need for high vigilance to suspect an infective aetiology of scleritis in patients with immunocompromised status. Prompt microbial assessment and appropriate antifungals can decrease morbidity in these unusual but serious cases as illustrated in this case.