Case Report: Endogenous Fusarium solani endophthalmitis without evident disseminated infection or fungemia after allogeneic hematopoietic stem cell transplantation

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Objective We report a case of a surviving adult male patient in whom endogenous endophthalmitis (EE) was the only manifestation of invasive fusariosis following allogeneic hematopoietic stem cell transplant (AHSCT), without any evidence of fungemia or involvement of other organs. Methods An 18-year-old male patient with Philadelphia chromosome-positive pre-B acute lymphoblastic leukemia underwent AHSCT with prophylactic posaconazole and liposomal amphotericin B but developed Fusarium EE. The patient first underwent a vitrectomy in the affected eye but was eventually successfully managed by enucleation of the involved eye. Results The patient’s ocular condition worsened despite the vitrectomy and administration of intravitreal antibiotic and antifungal agents. Samples obtained during the vitrectomy revealed Fusarium infection. The patient promptly underwent enucleation of the involved eye. A detailed laboratory workup and imaging revealed no evidence of fungemia or involvement of other organs. The patient is alive, with uneventful ophthalmological and hematological follow-up. Conclusions Fusarium EE may occur in the absence of fungemia or disseminated disease after AHSCT. Any ocular signs or symptoms must be viewed with a high index of suspicion and must be treated proactively in hematological malignancies to save the patient's life and transplant.