An elderly alcoholic with sepsis and fundoscopic exam showing patchy white retinal infiltrates bilaterally without papilledema most likely has which diagnosis?

• A. Candidal ophthalmitis
• B. Bacterial endophthalmitis
• C. CMV retinitis
• D. Toxoplasmosis retinochoroiditis

Answer: (A)

This pattern reflects endogenous fungal endophthalmitis from candidemia. In debilitated patients with sepsis, Candida can spread hematogenously to the retina, producing fluffy white chorioretinal infiltrates that are often bilateral. Papilledema isn’t a feature of this process, and the appearance described fits Candida seeding of the retina more than other causes.

CMV retinitis tends to occur in severe immunosuppression (like AIDS) with necrotizing retinal lesions and hemorrhages, often described as “pizza pie” retinopathy. Toxoplasmosis retinochoroiditis usually shows focal necrotizing retinitis with overlying vitritis and is often unilateral. Bacterial endophthalmitis typically presents with acute intraocular inflammation, pain, hypopyon, and vitreous opacities rather than discrete patchy white retinal infiltrates.