Purpose: To highlight diagnostic challenges and treatment strategies for endogenous fungal endophthalmitis caused by Coccidioides immitis in immunosuppressed patients or those residing in endemic areas. Methods: Two cases of endogenous fungal endophthalmitis were analyzed. Clinical presentations, diagnostic processes, and treatments were evaluated, emphasizing diagnostic delays and outcomes. Both cases involved patients with systemic risk factors for coccidioidomycosis, presenting with severe ocular inflammation and requiring multidisciplinary management. Results: A 50-year-old male with disseminated coccidioidomycosis presented with chronic anterior uveitis progressing to endophthalmitis. Diagnosis was confirmed via vitreous culture four weeks post-sampling, after negative aqueous culture. Intravitreal and systemic antifungals improved vision to 20/150. A 71-year-old male with a history of liver transplantation and immunosuppression presented with acute pain and vision loss. Diagnosis was confirmed by vitreous culture in 19 days. Empiric antifungal therapy led to partial recovery to counting fingers at one foot. Conclusions: Coccidioidomycosis can cause vision-threatening endophthalmitis, particularly in immunosuppressed patients or those in endemic areas. Delays in culture-based diagnosis underscore the value of serological testing. Standardized protocols, early empiric antifungal therapy, and multidisciplinary care are vital for better outcomes. Lifelong antifungal therapy and vigilant follow-up are crucial to prevent recurrence.
Virdi et al. (Fri,) studied this question.