A rare case of fungal endophthalmitis caused by an entomopathogen

To report the first known case of exogenous fungal endophthalmitis caused by Corniculantispora psalliotae, managed successfully with intraocular antifungal therapy and adjunctive cryotherapy. A 56-year-old woman presented with pain and progressive vision loss in the left eye, six months after an insect bite–related ocular injury. She had previously received topical and oral antifungal therapy for a presumed fungal corneal ulcer. On examination, the left eye showed corneal edema, focal stromal infiltrates, hypopyon, and a lens abscess. B-scan ultrasonography revealed moderate vitreous echoes suggestive of endophthalmitis. Pars plana vitrectomy and lensectomy were performed, along with intravitreal injections of vancomycin, ceftazidime, and voriconazole. Vitreous biopsy smear showed septate fungal filaments, and culture yielded significant growth of Corniculantispora psalliotae, confirmed by DNA sequencing. The patient received additional intravitreal antifungals and systemic therapy. Due to persistent anterior segment inflammation and a cyclitic membrane seen on ultrasound biomicroscopy, targeted cryotherapy was performed. Clinical improvement followed, with resolution of infection and improvement in visual acuity to 20/125. This case highlights Corniculantispora psalliotae as a rare ocular pathogen and underscores the importance of comprehensive microbiological workup in atypical endophthalmitis. Adjunctive cryotherapy may be beneficial in cases with poor initial response and cyclitic membrane formation.