CHRONIC ENDOPHTHALMITIS DUE TO PYRENOCHETA ROMEROI IN AN IMMUNOCOMPETENT HOST—A CASE REPORT FROM SOUTHERN INDIA

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In Brief Purpose: Endophthalmitis due to Pyrenochaeta romeroi has not been reported in literature (PubMed, Medline). We report an interesting case of P. romeroi causing chronic endophthalmitis in an immunocompetent lady. Methods: Retrospective interventional case report. A 25-year-old immunocompetent lady presented with pain and redness in the left eye of 1-month duration. Her best-corrected visual acuity was 6/6 and 6/18 in the right and the left eyes, respectively. Slit-lamp examination of the left eye showed a corneal stromal scar, fibrinlike material in the anterior chamber, few retrolental cells, and normal fundus examination. Results: Aqueous taps on two occasions were negative for bacteria and fungi on routine smear, culture, and nested polymerase chain reaction. As inflammation recurred despite intravitreal voriconazole and amikacin injections, a lensectomy with vitrectomy was done. During vitrectomy, dense flocculent material was seen in the pars plana with only scleral indentation. The flocculent material grew a rare filamentous fungus called P. romeroi. The left eye underwent retinal detachment surgery with silicone oil insertion for a giant retinal tear at 2 months of follow-up. At 6 months of follow-up, her vision in the left eye was stable at 6/24 (Snellen) with no ocular inflammation. Conclusion: P. romeroi may need to be added in the list of rare fungi, which cause chronic endophthalmitis. Endophthalmitis due to Pyrenochaeta romeroi has not been reported in literature (PubMed, Medline). The authors report an interesting case of P. romeroi causing chronic endophthalmitis in an immunocompetent woman. The negative smears, cultures, and polymerase chain reaction for bacteria and fungi in the initial aqueous taps, visualization of the flocculent mass in the pars plana and peripheral retina only after lensectomy, and the growth of a rare fungus on culture from this flocculent mass posed a significant diagnostic and therapeutic challenge.

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