Chronic postcataract endophthalmitis caused by Penicillium species in an immunocompetent patient

Koji Kanda,1 Kei Takayama,1 Toshio Enoki,2 Masaru Takeuchi1 1Department of Ophthalmology, National Defense Medical College, Tokorozawa, Japan; 2Enoki Eye Clinic, Sayama, Japan Objective: Penicillium species are abundant, generally saprophytic, and widely distributed in the environment. On rare occasions, they cause endophthalmitis in immunocompromised patients or in immunocompetent patients with uncontrolled diabetic mellitus or immunosuppressive agents. We report a case of endophthalmitis caused by Penicillium species in an immunocompetent patient without any disorders. Case presentation: A 67-year-old woman presented with ocular pain, hyperemia, and blurred vision in her right eye. She was in an immunocompetent condition and had received cataract surgery without complications 3 months ago. Severe cell infiltration and a clump of 3 mm diameter were found in the anterior chamber of the right eye, and there was no abnormality in the posterior segment. Serum β-d-glucan was not elevated; bacterial culture, histological analysis, and PCR using aqueous humor did not detect any pathogen (28S rDNA 2.4×102 copies/mL). However, because the clinical findings suggested fungal endophthalmitis, antifungal medication was initiated. The inflammation was gradually resolved with contraction of the clump; however, it recurred 47 days after the initiation by discontinuation of antifungal medication. Examination of culture identified Penicillium species in samples from both the anterior chamber and the vitreous. Conclusion: Chronic postoperative endophthalmitis by Penicillium species can occur in an immunocompetent patient without any systemic diseases. Keywords: endophthalmitis, immunocompetent, Penicillium, postcatarac