Larzo Documents Treatment of Rare EFE

Cris Larzo, M.D., SERA physician, is the senior author and faculty physician, with five colleagues, who co-wrote an article that appears in the February 2012 issue of The International Journal of Clinical Ophthalmology and Visual Sciences.

The article describes diagnosis and treatment of endogenous fungal endophthalmitis, or EFE, a rare complication of disseminated fungal infection, or candida endophthalmitis, that generally has a poor prognosis and can result in blindness. The condition is difficult to diagnose, sometimes mimicking ailments that are more common and thereby engendering delays in treatment. Some studies say misdiagnosis of candida endophthalmitis is close to 50 percent, the article reports. A compromised immune system, serious chronic diseases, malignancies, IV drug use, and intravenous catheters are some of the underlying sources for the infection. Microorganisms then migrate through the blood stream to the retina and choroid. Care is complicated for EFE patients because treatment is toxic antifungal therapy.

In the recent article, Dr. Larzo and his co-authors who were ophthalmology and pathology colleagues at West Virginia Eye Institute in Morgantown, report a case in which the infection was successfully treated with intravitreal amphotericin B and systemic fluconazole. They describe the unusual case of EFE in a young man whose troubles likely began with a nail fungus. As an immunocompetent patient, his case was rare and the first of its kind reported in North America. Most patients who contract this disease have debilitating diseases such as leukemia, end-stage liver disease, or HIV, so they are at higher risk than patients whose immune systems are functioning normally.

Dr. Larzo’s patient was first seen by an outside optometrist who referred him to the Eye Institute physicians. The patient complained of eye redness, light sensitivity, pain, floaters, and blurred vision in his left eye.

The patient later admitted to IV drug use which greatly increased the chance of the nail fungus spreading to his eye. The article describes the intricate, step-by-step process of diagnosing the patient and consequent varieties of drugs used to isolate the infection and stop the damage to his vision. Interestingly, Dr. Larzo says that just a couple of months ago another similar case was been reported in that location, so there may be a unique strain of the fungus circulating in that part of WV.

You may read an abstract of the article online at the National Center for Biotechnology Information (a division of the National Institutes of Health) where you also will find links to various subscription-based sites to download or read the full article. Dr. Larzo and his co-authors were colleagues when he served his residency in the Department of Ophthalmology at WVU Eye Institute. More than a year ago, Dr. Larzo joined SERA in the Kingsport office. He was already acquainted with another WVU colleague, Allan Couch, a Kingsport SERA physician who joined the practice in 2002.

“It was a difficult decision to relocate my practice from West Virginia,” Dr Larzo says, “but I’ve been totally satisfied with the move.

“I can’t imagine its going any better. My philosophy of patient centered practice fits perfectly with the SERA vision. The staff treat me like gold, and the patients have been warm and welcoming.”

Dr. Larzo and his wife, a pediatrician, are rearing their three young children in Johnson City. They enjoy the outdoors in scenic East Tennessee, and are active in Grace Fellowship Church. Read more about Dr. Larzo and other SERA vitreoretinal surgeons here.