Posttraumatic Endophthalmitis Caused by Medicopsis romeroi Case Report and Analysis of a Comprehensive Case Series

Fungal exogenous endophthalmitis is rare. Here, we report a case of posttraumatic endophthalmitis caused by Medicopsis romeroi in a 64-year old man. After a tree branch punctured his right eye while hiking in Laos, the patient's symptoms included pain, blurry vision, limited vision of light and dark, and sensation of a foreign body. The patient was unsuccessfully treated in Thailand with itraconazole and intraocular amphotericin. Upon return to the United States, the patient underwent extensive ophthalmic surgery and voriconazole was prescribed. Fundoscopic examination showed resolution of inflammation 3 months after the surgery, but despite symptomatic improvement, severe visual deficits remained. We performed a comprehensive case review of reported cases of M. romeroi infection, revealing that M. romeroi commonly manifests as a subcutaneous infection on the extremities in immunosuppressed patients who usually resolved with antifungal and surgical therapy. Many patients living in temperate climates were reported to have a travel and/or an immigration pattern from a tropical zone. This case and review extend the clinical spectrum of Medicopsis to include ocular infections, illustrates the importance of considering rare pathogens in patients with exogenous endophthalmitis, and encourages prompt medical and surgical treatment of Medicopsis.