heroin and Endophthalmitis

Fungal nervous system infection can be a difficult diagnosis to make, due to the fact that there are no specific manifestations of the disease and laboratory confirmation is difficult to confirm.. We report a young male who presented to our emergency department with a variety of unilateral visual field complaints. While he initially denied recent IV drug abuse, his physical examination was highly suggestive of a fungal infection known to result from brown heroin use. He was ultimately diagnosed with meningitis, ventriculitis, and endogenous endophthalmitis believed to result from a Candida species. The response to treatment with vitrectomy and broad-spectrum antimicrobials gave support to the presumed diagnosis. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: We provide a rarely described report of a possible complication from the use of IV brown heroin that led to a central nervous system infection involving vision loss by fungal infection.

Topics: Antifungal Agents; Candida; Central Nervous System Diseases; Cerebral Ventriculitis; Diagnosis, Differential; Emergency Service, Hospital; Endophthalmitis; Heroin; Humans; Male; Meningitis; Mycoses; Substance Abuse, Intravenous; Visual Fields; Voriconazole; Young Adult

Topics: Abscess; Adult; Candidiasis; Combined Modality Therapy; Endophthalmitis; Heroin; Heroin Dependence; Humans; Injections, Intravenous; Male; Streptococcal Infections

The presentation and management of 10 cases of proven or presumptive fungal endophthalmitis in narcotic-drug abusers is described. Miconazole was found to be an effective agent in some patients when administered in a dosage of 2400 mg/day. Eight patients received treatment with a combination of miconazole and flucytosine (5-fluorocytosine). Regression of the infection with preservation of the eye was observed in each case. However, visual acuity in the affected eye improved only in four of the eight patients; it was unchanged in two and had deteriorated in the other two. In two patients, who received amphotericin B and flucytosine as initial treatment, control of the infection was achieved, but vision remained unchanged. Vitrectomy was performed in three patients to remove residual sites of infection. However, vision remained unchanged in two of these patients and worsened in the third. The selection of individual modalities of therapy and responses to treatment are discussed.

Topics: Adult; Amphotericin B; Candidiasis; Drug Therapy, Combination; Endophthalmitis; Female; Flucytosine; Heroin; Humans; Male; Miconazole; Mycoses; Substance-Related Disorders; Visual Acuity; Vitrectomy

Topics: Adult; Amphotericin B; Candidiasis; Diagnosis, Differential; Endophthalmitis; Female; Heroin; Heroin Dependence; Humans; Injections, Intravenous; Male; Toxoplasmosis, Ocular

Topics: Adult; Candidiasis; Endophthalmitis; Heroin; Humans; Injections, Intravenous; Male