Fungal endophthalmitis in acute leukaemia

A 36-year-old man was admitted with a 3-month history of progressive visual loss in his left eye. The patient had had acute myeloid leukaemia (French– American–British category M3), which had responded to induction therapy, and was currently receiving consolidation treatment. Colour retinal photography showed a cotton wool-ball opacity over the left macula (top), with no lesions in the right eye. Visual acuity was 20/200 and 20/20 respectively. A diagnosis of monolateral fungal endophthalmitis was made and oral fluconazole (400 mg/d) prescribed. One month later, his vision had improved in the left eye to 20/25 and the fundus appeared normal (bottom). Fungal endophthalmitis typically develops in patients with systemic risk factors, such as debilitation, intravenous drug abuse, long-term intravenous treatment, malignancies, immunosuppression, recent major surgery, or trauma or indwelling bladder catheters.