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Presumed ocular candidiasis in drug misusers after intravenous use of oral high dose buprenorphine (Subutex)
  1. N Cassoux1,
  2. B Bodaghi1,
  3. P Lehoang1,
  4. Y Edel2
  1. 1Department of Ophthalmology, Pitié-Salpêtriére Hospital 47–83 bd de l’Hôpital, 75651 Paris, cedex 13, Paris, France
  2. 2Department of Public Health, ECIMUD (Hospitalised Drug Abusers Medical and Psychiatric Support Team) Pitié-Salpêtriére Hospital 47–83 bd de l’Hôpital, 75651 Paris, cedex 13, Paris, France
  1. Correspondence to: Phuc Lehoang; nathalie.cassoux{at}psl.ap-hop-paris.fr

https://doi.org/10.1136/bjo.86.8.940

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    Heroin drug misusers are a high risk group for disseminated candidiasis.1 Recently, an oral substitute for heroin with oral methadone or high dose sublingual buprenorphine tablets (Subutex) (HDSB) has proved to be effective in management of opioid addiction.2 We report the first four cases of presumed candida endophthalmitis following intravenous injection of HDSB.

    Case reports

    Case 1

    A 22 year old man, HIV negative, former heroin misuser, was seen complaining of blurry vision in his right eye. He used HDSB intravenously, after dissolution in saliva. One week following an injection, he presented with a febrile septicaemic syndrome associated with scalp nodules. Funduscopy revealed a moderate vitritis and a white tiny perifoveolar lesion with few white snowballs (Fig 1). The bacterial and fungal cultures from both blood and anterior chamber tap were negative. Treatment was begun with intravenous fluconazole associated with three intravitreal amphotericin B injections (IVT). After 15 days of therapy, he was discharged on oral fluconazole. Ten days later, the endophthalmitis relapsed with development …

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