We report findings for a 74-year-old woman with Candida tropicalis
endophthalmitis for whom an increase in b-
D-glucan level and worsening of
endophthalmitis were observed after
intravenous injection of
micafungin, an
echinocandin antifungal agent. Endogenous
endophthalmitis caused by C. tropicalis developed in both eyes. On the basis of her surgical history, laboratory data,and lesions, tentative diagnosis of fungal
endophthalmitis was made. She was then treated with
fluconazole and
itraconazole, but the b-
D-glucan level did not decrease, and there was no improvement of the
endophthalmitis. The
fluconazole was discontinued and replaced by
micafungin.Unexpectedly, the level of b-
D-glucan increased and
endophthalmitis did not improve. The
micafungin was immediately stopped and replaced by intravenous
fluconazole with
amphotericin B syrup, but the
itraconazole was continued. Marked resolution of the vitreous
inflammation was observed in both eyes, and the serum b-
D-glucan level was reduced. Because active macular infiltrates were observed in the right eye,
vitrectomy was performed. The
micafungin minimum inhibitory concentration against the C. tropicalis strain isolated from our patient was 0.03 lg/ml. This paradoxical effect of
micafungin should be remembered, and b-
D-glucan level should be frequently monitored after
intravenous injection of
micafungin.