[Case of fungal endophthalmitis developed after subtenon injections of triamcinolone acetonide].

BACKGROUND

We report a case of fungal endophthalmitis which developed after subtenon injections of triamcinolone acetonide (TA).

CASE

A 63-year-old man had Graves' ophthalmopathy. He had received subtenon injections of TA in his left eye. He was admitted to Kimura Eye & Internal Medicine Hospital because of a subconjunctival abscess with inflammatory cells in the anterior chamber. Although we treated it as a suspected bacterial infection at the first visit, it deteriorated rapidly. Because prolonged antibiotics and antifungal therapy seemed ineffective, we performed diagnostic surgery. The lower sclera around the subtenon injections of TA was hard and thick, and a white spotty lesion and retinal detachment were seen on the lower retina. A culture of the Tenon sac showed filamentous fungus. After the surgery the subconjunctival abscess recurred because intravenous antifungal therapy had been discontinued. A culture of the abscess identified Alternaria sp. The subconjunctival abscess, thickened sclera, and retinal exudate were limited to the region of the sub-Tenon injection of TA, We conclude that the sclera had been permeated by hyphae of Alternaria sp.

CONCLUSION

In this case, critical infection was caused by the sub-Tenon injections of TA.