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Background
Masquerade syndromes are a group of infectious and non-infectious disorders that can present initially as intraocular inflammation, and are often misdiagnosed as chronic idiopathic uveitis. 1 Although most patients with postoperative endophthalmitis will present with severe acute inflammation, some will have a chronic indolent intraocular infection. In cases of fungal infections, and as the infection progresses, fungus fluff balls will form in addition to the associated anterior uveitis and vitreous inflammation, in a seemingly quiet eye; a picture simulating pars planitis. Only appropriate diagnosis and timely intervention will improve the patient's outcome. 2 Systemic and intravitreal antimicrobial therapy with removal of the residual capsule and IOL will be required in cases with chronic recurrent or recalcitrant disease. 3
Case presentation
A 47-year-old woman was referred with chronic intermediate uveitis for further evaluation. On presentation, the patient had seemingly quiet eyes, with 5/60 vision in the right eye, 2+ anterior chamber (AC) cell, mild flare, 3+ vitreous cell and moderate haze, an inferior snowball with some vitreous condensations, and mild disc hyperaemia. Vision in the left eye was 6/6 with no signs of intraocular inflammation ( figure 1 A-C). Both eyes were pseudophakic as the patient reported having had bilateral successive uneventful cataract surgeries 9 months prior to presentation. No history of diabetes or any other associated systemic disease was noted. The patient had been using topical and systemic steroids for 7 months prior to presentation, with no improvement. Considering that the snowball vitreous opacities were possibly retained lens fragments causing lens induced uveitis, a posterior subtenon steroid injection was performed elsewhere, followed by incomplete vitrectomy, with no success ( figure 1 D). The patient had a recent...