Ocular Candidiasis Following COVID-19 Hospitalization: A Case Report

Purpose: Coronavirus Disease 2019 (COVID-19) is a complex infectious pathology characterized by systemic inflammation. Monoclonal antibodies are being currently being tested to reduce inflammation, but their long-term effects are unknown. The purpose of this report is to give an insight on late manifestations of the disease, including unusual ocular involvement. Patients: We describe a case of an immunocompetent 57 years old man, presenting with a decreased visual acuity after COVID-19-related pneumonia and ARDS. He underwent mechanical ventilation and received Tocilizumab. After recovery from respiratory failure and seroconversion, SARS-CoV-2 was persistently not detected on nasopharyngeal swab, but inflammatory markers and interleukin-6 were persistently elevated. Several haemocultures confirmed Candida albicans. The ophthalmologic examination detected a unilateral (left eye) chorioretinitis. Intravenous voriconazole was administered with complete resolution of both clinical and ophthalmoscopic findings. Conclusion: This is a case report on COVID-19 respiratory distress and haematogenous candida spp. spread leading to unilateral chorioretinitis. Candidiasis is likely more common than what is reported during and after critical illness. Furthermore, anti-inflammatory targeted-therapy such as Tocilizumab, may interfere on long-term immune response. For this reason, coinfections should be carefully investigated, and ophthalmologic examination should be performed in presence of candidemia.