Candida auris and endogenous panophthalmitis: clinical and h
A 30 year-old man with human immunodeficiency virus (HIV) and polysubstance abuse presented with painful right eye vision loss over one day. Three weeks elsewhere, he was treated for syphilis and pneumonia of unknown etiology.
Examination revealed a normal left eye, and no light perception in the right eye. There was proptosis, chemosis, mucopurulent corneal discharge, haze, and hypopyon. Vitreous opacities limited posterior visualization. Extraocular motility was absent. Treatment included intravenous vancomycin, metronidazole, ganciclovir, and cefepime. Blood cultures were negative, but urine culture showed pan-sensitive Pseudomonas aeruginosa. Intravitreal vancomycin and ceftazidime were injected.

Orbital edema worsened over 5 days. Vitreous aspiration was performed with intravitreal amphotericin B and additional ceftazidime and vancomycin injections. After previous refusals, enucleation was finally elected. Enucleation specimen demonstrated fulminant inflammation with profound polymorphonuclear infiltration in all tissue layers. Vitreous and enucleation cultures both demonstrated Pseudomonas aeruginosa and Candida auris. Clinical improvement prompted initiation of highly active anti-retroviral therapy and eventual discharge with systemic ciprofloxacin and micafungin.

Identification of cerebral hematoma with midline shift and mycotic aneurysm prompted glue embolization. Pseudomonal meningitis with multiple brain lesions, spinal infection, respiratory failure, hydrocephalus, and ultimately, herniation followed. Supportive care was withdrawn, and the patient expired. Candida auris has been a recently and increasingly described pathogen leading to mortality. To the authors’ knowledge, Candida auris has not previously been reported with endophthalmitis or panophthalmitis.