Voriconazole Treatment for Fungal Chorioretinitis After Obesity Surgery

Presently described is a case of fungal septicemia diagnosed based on a fundus examination and successfully treated with voriconazole. A 48-year-old woman who had undergone sleeve gastrectomy 20 days prior due to obesity was referred to the ophthalmology clinic for blurred vision in the right eye. The initial examination indicated visual acuity of only light perception in the right eye and 0.00 logMAR in the left eye. Anterior segment examination and light reaction results were normal in both eyes. The vitreous was clear. A central, hemorrhagic, hypopigmented lesion 1/3 optic disc diameter in size, was located in the right fovea, bulging from the retina. There were 3 or 4 small hypopigmented lesions in both peripheral retinas. The examination findings and patient history suggested fungal chorioretinitis. The patient was treated with intravenous voriconazole at a maintenance dose of 200 mg 2 times a day following a loading dose of 6 mg/kg 2 times a day for 48 hours according to the recommendation of the infectious diseases clinic. Multimodal imaging using fundus photography, fluorescein angiography, and spectral domain optical coherence tomography was performed throughout treatment. The patient’s daily follow-up revealed no deterioration and improvement was seen on the third day. Endogenous fungal chorioretinitis is a rare infection, but it remains important in ophthalmology due to the high potential to cause severe visual loss and the limited diagnosis and treatment options. Patients who are susceptible to fungemia and have a recurrent fever may be referred to an ophthalmologist. Many clinical tests may have negative results but a careful fundoscopic examination can determine signs of fungemia-related chorioretinitis.