Endogenous Scedosporium apiospermum endophthalmitis with concurrent cytomegalovirus retinitis: a case report

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Endogenous Scedosporium apiospermum endophthalmitis complicated by cytomegalovirus retinitis and fungal infective endocarditis (n=1). Intervention: Vitrectomy, oral and intravitreal voriconazole, and intravitreal ganciclovir. Primary outcome: Ocular lesion regression and clinical outcome.

Q: What does this research mean for the field?

Endogenous Scedosporium apiospermum endophthalmitis can co-occur as a mixed retinal infection with cytomegalovirus retinitis in severely immunocompromised patients, with fungal lesions responding to voriconazole and vitrectomy despite systemic dissemination. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

Ken Fukumoto; Yukako Hiramatsu; Tomohiko Torikai; Hidenori Inoue; Koji Toriyama; Atsushi Shiraishi

doi:10.1186/s12348-026-00665-z

November 12, 2026Journal of Ophthalmic Inflammation and InfectionOpen Access

Endogenous Scedosporium apiospermum endophthalmitis with concurrent cytomegalovirus retinitis: a case report

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Key result

Voriconazole and vitrectomy regress fungal retinitis, but fatal endocarditis and CMV superinfection complicate survival.

n=1

Why the study?

Endogenous endophthalmitis caused by Scedosporium apiospermum complicated by concurrent cytomegalovirus retinitis during treatment is rare.

Key Points

To report a rare case of endogenous Scedosporium apiospermum endophthalmitis complicated by concurrent cytomegalovirus retinitis during immunosuppressive therapy.
Clinical evaluation, surgical management, and autopsy examination of a 65-year-old immunosuppressed woman with dermatomyositis presenting with bilateral hypopyon and vitreous opacities.
Diagnostic procedures included repeat vitrectomy, retinal mass fungal culture with genetic sequencing, broth microdilution susceptibility testing, and aqueous humor polymerase chain reaction (PCR) for cytomegalovirus (CMV) DNA.
Retinal mass culture and genetic analysis identified S. apiospermum (voriconazole minimum inhibitory concentration 2 µg/mL), and aqueous humor PCR subsequently detected CMV DNA at 4 × 10⁷ copies/mL.
Treatment with systemic and intravitreal voriconazole (0.1 mg/0.1 mL) regressed fungal lesions, while intravitreal ganciclovir (1 mg/0.05 mL) yielded slight improvement in CMV retinitis lesions before the patient died from acute exacerbation of interstitial pneumonia on hospital day 69.
Autopsy revealed a 2-cm mitral valve vegetation with Grocott-positive filamentous fungi and retinal histopathology showing concurrent filamentous fungi and CMV-immunopositive cells with intranuclear inclusions.

Study Design

Type

Case Report (n=1)

Multicenter

No

Structured PICO

P

Population

1 65-year-old immunosuppressed woman with anti-MDA5 antibody-positive dermatomyositis and interstitial pneumonia presenting with bilateral endogenous Scedosporium apiospermum endophthalmitis, followed for 69 hospital days until death.

I

Intervention

Pars plana vitrectomy, oral voriconazole (300 mg/day), intravitreal voriconazole (0.1 mg/0.1 mL), and intravitreal ganciclovir (1 mg/0.05 mL)

This case report highlights that Scedosporium apiospermum can cause life-threatening disseminated infection including mitral valve infective endocarditis and endogenous endophthalmitis, which can be further complicated by concurrent opportunistic CMV retinitis in severely immunocompromised patients.

Limitations

Single patient case report
Fungal species in the mitral valve vegetation and left eye could not be definitively identified by molecular analysis
Initial CMV PCR testing was not performed on the left eye at presentation, making the exact onset of CMV retinitis uncertain
Detailed neuropathologic examination was not performed at autopsy to confirm the exact mechanism of cerebral hemorrhage and infarction
It was not possible to definitively identify the fungal species in the mitral valve vegetation and the left eye.
Neither the route of infection nor the causal relationships among the mitral valve and bilateral ocular lesions could be established.
Because a detailed neuropathologic examination was not performed, the exact underlying mechanisms of the intracerebral hemorrhage and cerebral infarction remain uncertain.
PCR test for CMV in the left eye was not performed at the initial visit, making it impossible to determine whether CMV retinitis developed during follow-up or was pre-existing.

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Implication

Supports vigilance for concurrent CMV retinitis in immunosuppressed patients with Scedosporium endophthalmitis; leaves open optimal management strategies.

Abstract

Purpose To report a rare case of endogenous endophthalmitis caused by Scedosporium apiospermum ( S. apiospermum ) complicated by cytomegalovirus (CMV) retinitis during treatment. Observations A 65-year-old woman developed bilateral floaters and visual deterioration while receiving systemic immunosuppressive therapy for dermatomyositis and interstitial pneumonia. She had previously been treated with oral voriconazole for cutaneous aspergillosis. Bilateral hypopyon and vitreous opacities were observed. Despite vitrectomy and systemic antifungal therapy, the intraocular inflammation worsened. Culture of a retinal white mass obtained during repeat vitrectomy identified S. apiospermum by genetic analysis. Oral and intravitreal voriconazole were administered, resulting in the regression of fungal lesions. However, granular retinal lesions subsequently appeared in the left eye, and CMV DNA (4 × 10⁷ copies/mL) was detected on polymerase chain reaction (PCR) of the aqueous humor, leading to a diagnosis of CMV retinitis. Intravitreal ganciclovir injections were added. The patient later developed intracerebral hemorrhage and embolic cerebral infarction and died of acute exacerbation of interstitial pneumonia. Autopsy revealed fungal vegetation on the mitral valve consistent with infective endocarditis. Histopathology confirmed a mixed infection of filamentous fungi and CMV in the retina Conclusions and Importance S. apiospermum can cause endogenous endophthalmitis and life-threatening systemic infection. In immunocompromised patients, clinicians recognize the possibility of mixed infections and carefully perform fundus examinations during treatment.

Discussion

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Cite This Study

Fukumoto et al. (2026) conducted a case report in Endogenous Scedosporium apiospermum endophthalmitis complicated by cytomegalovirus retinitis and fungal infective endocarditis (n=1). Vitrectomy, oral and intravitreal voriconazole, and intravitreal ganciclovir was evaluated on Ocular lesion regression and clinical outcome. Voriconazole and vitrectomy regressed Scedosporium apiospermum retinal lesions in a 65-year-old woman, though concurrent CMV retinitis and fatal endocarditis occurred.

synapsesocial.com/papers/6af73ac79badce7b6084da3b https://doi.org/10.1186/s12348-026-00665-z

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Endogenous Scedosporium apiospermum endophthalmitis with concurrent cytomegalovirus retinitis: a case report

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Endogenous Scedosporium apiospermum endophthalmitis with concurrent cytomegalovirus retinitis: a case report

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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