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R. W. Sedeek, M. Shah, R. Gentile, C. M. Samson; First Case Report of Candida Dubliniensis Endogenous Endophthalmitis. Invest. Ophthalmol. Vis. Sci. 2008;49(13):952.
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To report the first case of Candida dubliniensis endogenous endophthalmitis in an immunocompetent individual.Methods / Case presentation: 38 year old male with no significant past medical history presented with 8 week-history of pain, redness and gradual decrease in vision in the right eye. He denied trauma, ocular procedures, intravenous drug use, and any systemic symptoms. Social history is significant for working in maintenance at an old school building where the ceiling of his working shop had a leak that was dripping foul liquid from the toilet above. Two months prior to presentation, he also had to drain an abandoned indoor pool that had foul water infested with dead rats.On presentation, vital signs were normal; visual acuity in the right eye was hand motion and in the left eye was 20/20. Intraocular pressure in the right eye was 5 and in the left eye was 18. On slit lamp exam, right eye had an injected conjunctiva, hypopyon, fluffy white nodules on the iris with no view of the posterior pole. An ultrasound showed vitreous opacity with no retinal detachment. Left eye exam was normal. Patient was immediately taken to the operating room for anterior chamber paracentesis, tap for culture, synechiolysis, pars plana lensectomy, vitrectomy, vitreous culture and intravitreal injection of Vancomycin and Ceftazidime
Four days later, the anterior chamber and the vitreous cultures grew C. dubliniensis (sensitive to Amphotericin B, Fluconazole, Voriconazole, and Caspofungin). C. dubliniensis was initially identified with the commercial yeast identification system VITEK 2ID-YST and the no growth pattern at 45 degrees. This was confirmed by PCR at the New York State Department of Health Wadsworth Center for Lab & Research Mycology Laboratory. Patient was treated by an intravitreal injection of Amphotericin B, topical Amphotericin B, and systemic Voriconazole 200 mg PO Q12hour. He also underwent a thorough work-up for a primary source by an infectious disease specialist. No signs of systemic infection or immunocompromise could be found.
C. dubliniensis is a novel Candida subspecies that was first reported in oral candidiasis of HIV-infected individuals in 1995. This is the first case report of C. dubliniensis endogenous endophthalmitis in an immunocompetent individual. C. dubliniensis is closely related phylogenetically to C. albicans, but it is important for ophthalmic microbiology laboratories to be aware of its presence and to be able to properly differentiate it from C. albicans.
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