Images Dx

“String‐of‐pearls”

Copyright © 2008 Society of Hospital Medicine

A 41‐year‐old intravenous drug user (IVDU) was admitted with candidal endophthalmitis 6 weeks after a hospitalization for pneumonia. After discharge from his previous hospitalization which were blood cultures grew Candida albicans, attributed to contamination by a covering physician. The patient described looking through spider webs. Fundoscopic examination revealed fluffy, white string‐of‐pearls opacities with retinal obscuration (Fig. 1). There were no findings of endocarditis (negative echocardiogram) or congestive heart failure. Blood and vitreal cultures grew Candida albicans. The patient underwent a pars plana vitrectomy, and was prescribed chronic fluconazole. He was lost to follow‐up.

Figure 1

Patient's retinal examination revealing vitreal fluffy white “string‐of‐pearls” opacities.

Candida albicans is the most common organism identified in endogenous endophthalmitis.1 Predisposing factors include IVDU, indwelling catheters, endocarditis, recent surgeries, immunosuppression, broad‐spectrum antibiotics, and parental nutrition.1 The diagnosis is based on retinal findings of white pinpoint opacities (string‐of‐pearls, Fig. 2), with vitreous involvement and positive cultures. Endocarditis occurs in 15%17% of patients with endophthalmitis.2 This case highlights the importance of physician recognition of the significant attributable morbidity and mortality of candidemia.3, 4

Figure 2

The proverbial … “string‐of‐pearls.”

References

   Comments ()