Consecutive presumed endogenous candida endophthalmitis and presumed cytomegalovirus uveitis in an immunocompromised patient: a case report.

BACKGROUND: Consecutive intraocular infections with candida and cytomegalovirus in the same eye are exceptionally rare. This case report describes the unique presentation, diagnostic challenges, and management of sequential presumed endogenous candida endophthalmitis and presumed cytomegalovirus uveitis in an immunocompromised patient, highlighting the importance of vigilant clinical assessment and aggressive treatment for preserving visual function. CASE PRESENTATION: A 46-year-old immunocompromised Caucasian male patient with history of rheumatoid arthritis on long-term oral methylprednisolone presented with blurry vision and floaters in his left eye. Initial examination revealed yellowish fluffy retinal lesions with emerging fungal balls in the vitreous compatible with presumed endogenous candida endophthalmitis. His condition progressed despite intravitreal injections, necessitating pars plana vitrectomy. Two months post-surgery, the patient developed recurrent hypertensive uveitis with bleeding along the retinal vessels compatible with intraocular cytomegalovirus infection. The patient's visual acuity fluctuated significantly throughout the course of treatment, from hand motion to 20/70, before ultimately improving to 20/40 with appropriate management. CONCLUSION: This case highlights the risk of severe, sequential intraocular infections in immunocompromised patients and the importance of astute clinical observation and high index of suspicion. Favorable visual outcomes can be achieved through prompt, tailored treatment and long-term follow-up.