The Unrelenting Non-sporulating Hyphae

A 42-year-old man presented with generalized redness in the left eye and painless blurring of vision for four days. He also had a fever and a large left leg abscess for four days prior to the onset of eye symptoms. Visual acuity of the left eye was hand movement with a positive relative afferent pupillary defect. Conjunctiva was injected with chemosis and mild corneal haziness centrally. There was a presence of whitish fibrin covering the pupil and presence of hypopyon with anterior chamber inflammatory cells. The fundoscopic view was obscured by the presence of fibrin in the pupillary area. B-scan ultrasound showed severe vitritis with multiple loculations. He was treated as left eye endogenous endophthalmitis secondary to left leg abscess. He was given multiple intravitreal antibiotic injections together with intravenous ceftazidime and gutt. moxifloxacin. The vitreous specimen did not yield any growth. Incision and drainage were done for the left leg abscess, and yellowish pus was aspirated with negative culture. Trans-pars plana vitrectomy was performed in view of poor clinical response. However, despite that, his left visual acuity dropped to non-perception of light (NPL). The vitreous specimen taken during vitrectomy finally showed non-sporulating fungal hyphae. He was started on oral fluconazole and topical amphotericin B. His left eye remains as NPL. However, his general eye condition improved.