A rare encounter: Fusarium falciformis and the challenges of ocular infection in the context of biologic therapy

This case report presents a patient with exogenous endophthalmitis caused by Fusarium falciformis, highlighting the risks associated with immunosuppressive therapy using Adalimumab for rheumatoid arthritis. The patient's compromised immune system, likely exacerbated by gardening exposure, facilitated the fungal infection, marking the first documented instance of Fusarium-related endophthalmitis linked to Adalimumab. Fusarium species are prevalent in the environment but are infrequently recognized as pathogens in humans, particularly in immunocompromised individuals. The differentiation between infectious and non-infectious ocular inflammation poses a significant challenge for clinicians. In this case, early involvement of ophthalmology was critical, leading to effective treatment strategies. Notably, in vitro testing revealed unexpected sensitivity of the isolated Fusarium strain to amphotericin B, which, combined with posaconazole, proved beneficial when combined with intravitreal injections of amphotericin B. This underscores the importance of tailored therapeutic approaches for rare ocular fungal infections and the necessity for increased awareness among healthcare providers regarding potential ocular adverse effects of biologic therapies. Ultimately, this case serves as a vital reminder of the complexities in managing ocular infections in patients receiving immunomodulatory treatments, advocating for vigilant assessment and prompt intervention to preserve vision.