We describe a case of endogenous fungal endophthalmitis (EFE) in a 38-year-old woman. On the 28th day after surgery for tongue cancer and following the insertion of a central venous catheter (CVC), fungemia developed along with a high fever. The fever subsided after antifungal drugs were administered. We continued to administer the antifungal drugs, but the patient complained of myodesopsia. Funduscopic examination revealed an exudative lesion, and we diagnosed EFE. Antifungal drugs were administered for 34 days after the diagnosis of EFE, and the patient recovered.
EFE occurs when a fungus enters the blood vessels via the site of an injury or catheter insertion in association with an opportunistic infection or an immunocompromised system caused by a comprehensive surgical procedure or by the long-term, high-dose administration of broad-spectrum antibiotics, antineoplastic agents, or immunosuppressive agents, resulting in fungemia.
A CVC has been placed in 90 percent of all patients with EFE. When treated at an early stage, the course is normally excellent, but delayed initiation of treatment may result in loss of vision. Most previous cases of EFE have involved the digestive system. An extensive search of the literature revealed only three cases of EFE occurring in the head and neck region that have been reported in Japan, including the case that we treated.
