Usefulness of voriconazole in treatment of Phoma glomerata after penetrating injury

We report the first case of endophthalmitis caused by Phoma glomerata. A 32-year-old man 62 who underwent retinal detachment surgery consecutive to a penetrating globe injury presented with endophthalmitis 7 days after surgery. Anterior chamber tap and intravitreal injection of antibiotics (ceftazidime and vancomycin) were performed systematically. Fungus was observed at microscopic examination of the aqueous humor and treatment with intravitreal injection of amphotericin B was decided. The patient failed to improve with intravitreal amphotericin B but responded clinically to intravitreal voriconazole. The fungus was identified after culture as Phoma glomerata. The MIC for amphotericin B was 1 mu g/ml, for caspofungin was 2 mu g/ml, and for itraconazole was 8 mu g/ml or more. The MIC for voriconazole was up to 8 mu g/ml. The clinical response after intravitreal injection may be related to the high concentrations reached in the vitreous. Because of severity and ominous prognosis of intraocular fungal infections and posttraumatic Phoma ocular infections, aggressive management is required by intravitreal voriconazole administration.