(558) A Case of Disseminated Scedosporium Fungemia With Endophthalmitis

Introduction: Scedosporium, primarily a non-Aspergillus mold, is a rare filamentous fungus that causes infection commonly in hematological malignancies via inhalation of spores into the lungs or paranasal sinuses about 10 to 25% of the time. It is increasingly associated with disseminated infections causing universal mortality. We present a rare case of a primary lung malignancy with disseminated Scedosporium infection complicated by endophthalmitis and voriconazole toxicity.

Description: An 83-year-old male with a history of rheumatoid arthritis on chronic prednisone therapy, lung cancer in the left lower lobe on radiation therapy, coronary artery disease with coronary bypass graft, atrial fibrillation, heart failure, COPD, presented with shortness of breath and blurry vision in the right eye. On arrival, he was found to have acute hypoxic respiratory failure requiring intubation and mechanical ventilation and required vasopressor support with norepinephrine in the setting of overwhelming fungal infection. A positive beta-d-glucan assay along with imaging findings consistent with brain, lung, skin, and eye involvement all confirmed the diagnosis of disseminated Scedosporium infection. His disseminated Scedosporium infection was complicated by recurrent brain abscesses requiring drainage, necrotizing pneumonia, stage 4 sacral ulcer, and endophthalmitis in the setting of an immunocompromised host. His hospital course was further complicated by acute left transverse, sigmoid sinus thrombosis, and CNS and liver toxicity to the first-line treatment of voriconazole. Treatment was transitioned to isavuconazole and micafungin therapy. Despite the best medical efforts, he was made comfort care and demised.

Discussion: Scedosporium is a rare non-Aspergillus genus of mold that can disseminate and has a significant cause of mortality in patients with malignancies or immunocompromised patients. Our case illustrates an extremely rare presentation of disseminated Scedosporium infection causing endophthalmitis. It is crucial for early detection and management of fungal infections in immunocompromised patients with appropriate fungal culture or indirect testing such as beta-d-glucan testing to improve the chance at survival.