Chronic basidiomycetous endophthalmitis after extracapsular cataract extraction and intraocular lens implantation

Background: Basidiomycetes are known as rare pathogens for meningitis, sinusitis, pneumonia, ulcerative lesions of the hard palate and onychomycosis. To our knowledge, no filamentous basidiomycete has been reported from a case of fungal endophthalmitis. Patient: We report on a 67-year-old man with delayed-onset endophthalmitis caused by an opportunistic basidiomycete. Tissue obtained during vitrectomy was cultured and examined by light and transmission electron microscopy. After enucleation the eye was examined by light microscopy. Conclusion: The patient had endophthalmitis from a sterile hyphomycete, harboured in remnants of lens capsule and a granuloma on the ciliary body. It was recognized as a Holobasidiomycete on the basis of its dolipore structure with perforated pore cap, seen with transmission electron microscopy. Species identification was not possible because fruiting bodies were absent. The patient failed to respond to intravitreal and systemic amphotericin B and systemic itraconazole. The eye was enucleated. This case demonstrates that filamentous basidiomycetes can cause endophthalmitis when inoculated during cataract extraction.