Indian Journal of Ophthalmology

LETTER TO EDITOR
Year
: 2004  |  Volume : 52  |  Issue : 3  |  Page : 253--4

Bilateral submacular abscess after induced abortion.


Gaurav Y Shah, A Pathengay, A Mathai, S Savitri 
 

Correspondence Address:
Gaurav Y Shah





How to cite this article:
Shah GY, Pathengay A, Mathai A, Savitri S. Bilateral submacular abscess after induced abortion. Indian J Ophthalmol 2004;52:253-4


How to cite this URL:
Shah GY, Pathengay A, Mathai A, Savitri S. Bilateral submacular abscess after induced abortion. Indian J Ophthalmol [serial online] 2004 [cited 2020 Mar 28 ];52:253-4
Available from: http://www.ijo.in/text.asp?2004/52/3/253/14578


Full Text

Dear Editor,

Surgically induced abortion rarely causes simultaneous bilateral submacular abscess. We report a case of bilateral submacular abscess due to Candida albicans following induced abortion in a healthy female.

A 23-year-old immunocompetent female was referred to our centre after she developed sudden, painless, decrease in vision three days following dilatation and curettage to terminate pregnancy at 8 weeks. She had fever and chills following the abortion for which oral ciprofloxacin 750 mg twice daily was given for five days.

On examination, her best corrected visual acuity was counting fingers at 1.5 m in both eyes. Anterior segment evaluation was within normal limits. Cells were noted in the vitreous. Creamy to yellow lesions, penetrating the retina and causing mushroom shaped projections into the vitreous cavity were noted in the submacular area of both eyes [Figure 1] a and b.

Based on the clinical features, a presumptive diagnosis of subretinal abscess due to Candida was made.

She underwent vitreous biopsy in the right eye with intravitreal amphotericin B (5 ug/0.1 ml) in both eyes. She was treated with oral itraconazole 100 mg twice daily and topical 5% natamycin eye drops ten times daily.

Vitreous microscopy showed gram-positive yeast. Vitreous culture on blood agar, chocolate agar and Sabouraud's dextrose agar showed significant growth of C albicans, identified by API 20 NE (Bio Merieux, France). Vagnal culture revealed Candida albicans.

During follow-up, vitritis and the abscess resolved. Oral itraconazole was discontinued after 6 weeks and topical 5% natamycin was stopped after 2 weeks. At two months' follow-up, her visual acuity had improved to 6/36 in both eyes. Fundus examination showed submacular scar in both eyes [Figure 2] a and b. The same findings were noted at her last visit at the end of six months.

Endogenous Candida endophthalmitis is rare in pregnancy.[1],[2] Hormonal changes occurring in pregnancy predispose the patient to fungal colonisation in the vagina.[3] Dilation and curettage done in our patient possibly inoculated the organisms into the blood stream. Both vitreous and vaginal culture was positive for Candida albicans .

The possibility of subretinal abscess due to Candida following abortion, though rare, should be recognised by ophthalmologists by its growth pattern. Timely and appropriate treatment could salvage vision.

References

1Sikic J, Vukojevic N, Katusic D, Saric B. Bilateral endogenous Candida endophthalmitis after induced abortion. Croat Med J 2001;42:676-78.
2Chen SJ, Chung YM, Lui JH. Endogenous Candida endophthalmitis after induced abortion. Am J Ophthalmol 1998;125:873-75.
3Bodey GP. Candidiasis: Pathogenesis, Diagnosis and Treatment , 2nd ed. New YorK: Raven Press. 1993. pp 286.