Scedosporium endophthalmitis: two fatal disseminated cases of Scedosporiuminfection presenting with endophthalmitis

The incidence of disseminated infection with Scedosporium species is increa sing in patients with haematological malignancy. Two fatal cases are report ed of patients with acute myeloid leukaemia and neutropenia who presented w ith Scedosporium endophthalmitis. Diagnosis of fungal infection was delayed as blood and vitreous cultures were positive only after 3 days in patient 1 and blood culture was positive at 7 days in patient 2. Despite antifungal therapy with amphotericin B and additional fluconazole in patient 2, both patients died of overwhelming fungal septicaemia. Post-mortem examination o f the right globe in patient 1 showed haemorrhagic necrotizing chorioretini tis with numerous fungal hyphae in choroidal vessels, choroid, retina and v itreous. Scedosporium species are often resistant to conventional antifunga l therapy including amphotericin B. Diagnosis is difficult and mortality in disseminated infection is high.