Candida endophthalmitis and infection of costal cartilages.

A 51-year-old man with a diagnosis of systemic lupus erythematosus developed floaters and blurred vision in his right eye. His ophthalmologist, noting the presence of vitreous debris in the right fundus, administered a retrobulbar steroid injection and prescribed 1 % prednisolone acetate drops every 2 hours. However, vision continued to deteriorate and he was admitted to Vanderbilt University Hospital. He was on chronic prednisolone therapy by mouth and had been treated intermittently with amphotericin and Mycostatin (nystatin) for oral candidiasis. A previous episode of staphylococcal infection in his left knee had responded to a prolonged course of methicillin 3 months earlier. There was no history of intravenous drug abuse. On admission the best corrected visual acuity was 6/18 right eye and 6/6 left eye. Biomicroscopy revealed a trace flare in the right anterior chamber. The vitreous was moderately infiltrated with inflammatory cells, and focal inflammatory lesions were evident along the superotemporal retinal vessel at the posterior pole. These lesions had the appearance of elevated cotton-white fluffy mounds. Smaller glistening yellow-white lesions were scattered along