A curious case of endogenous Ramularia endophthalmitis presenting as acute angle closure.

Abstract

Purpose: To report on an interesting case of fungal endogenous endophthalmitis in a patient that was referred in for acute angle closure. A unique presentation with a novel pathogen, Ramularia, identified on vitreous sampling.

Methods: Case report.

Results: This report describes a patient referred for presumed angle closure with a painful red left eye, an intraocular pressure of 39mmHg and perception to light vision. Ramularia species DNA - a novel fungus, was identified on PCR from sterile vitreous sampling during subsequent vitrectomy, performed due to worsening vision. Following vitrectomy, the patient improved with topical voriconazole and oral posaconazole which was second line therapy after oral voriconazole caused hepatoxicity. The patient had a good visual outcome with a final visual acuity of 20/50, 18 months post presentation.

Conclusion: This case highlights the unique presentation, treatment, and good outcome of a patient with endogenous endophthalmitis from a novel fungus, Ramularia.