Which ocular infection is most likely in a septic patient with sun-exposure risk factors and patchy retinal infiltrates?

Which ocular infection is most likely in a septic patient with sun-exposure risk factors and patchy retinal infiltrates?

• A. Candidal ophthalmitis
• B. CMV retinitis
• C. Bacterial keratitis
• D. Herpetic retinopathy

Answer: (A)

Endogenous endophthalmitis from a bloodstream infection is a classic concern in septic patients. Candida is the most common fungal culprit in this setting, and it often seeds the retina and choroid, producing patchy white retinal/infiltrative lesions (chorioretinitis) rather than a corneal or purely vascular pattern. The scenario fits Candida endophthalmitis: a septic patient with risk factors for fungemia develops ocular involvement that presents as patchy retinal infiltrates. CMV retinitis typically occurs in severely immunocompromised individuals (like advanced AIDS) and shows a characteristic “pizza pie” appearance with hemorrhagic necrosis, not the patchy retinal infiltrates described here. Bacterial keratitis targets the cornea, not the retina, so it wouldn’t explain retinal infiltrates. Herpetic retinopathy causes necrotizing retinitis with vascular involvement and is less specifically described as patchy retinal infiltrates in a septic patient. So the answer aligns with candidal ophthalmitis due to hematogenous spread to the retina in a septic patient.

Endogenous endophthalmitis from a bloodstream infection is a classic concern in septic patients. Candida is the most common fungal culprit in this setting, and it often seeds the retina and choroid, producing patchy white retinal/infiltrative lesions (chorioretinitis) rather than a corneal or purely vascular pattern. The scenario fits Candida endophthalmitis: a septic patient with risk factors for fungemia develops ocular involvement that presents as patchy retinal infiltrates.

CMV retinitis typically occurs in severely immunocompromised individuals (like advanced AIDS) and shows a characteristic “pizza pie” appearance with hemorrhagic necrosis, not the patchy retinal infiltrates described here. Bacterial keratitis targets the cornea, not the retina, so it wouldn’t explain retinal infiltrates. Herpetic retinopathy causes necrotizing retinitis with vascular involvement and is less specifically described as patchy retinal infiltrates in a septic patient.

So the answer aligns with candidal ophthalmitis due to hematogenous spread to the retina in a septic patient.