DR.MOHAMMED IRFAN SHEIKHabout 1 year ago

Endogenous Endophthalmitis

A 44-year-old man with diabetes mellitus and end-stage kidney disease presented to the emergency department with a 2-week history of pain and blurry vision in his left eye, fevers, and back pain. An ophthalmologic examination was notable for conjunctival injection and corneal clouding in the left eye. Visual acuity was 20/60 in the right eye and was reduced to minimal light perception in the left eye. Slit-lamp examination revealed a hazy, edematous cornea and a small hypopyon in the left eye. Cultures of vitreous fluid and blood grew methicillin-sensitive Staphylococcus aureus. A diagnosis of bacterial endogenous endophthalmitis was made. Endophthalmitis is a vision-threatening infection of the vitreous and aqueous fluids of the eye. The infection is deemed to be endogenous when it results from hematogenous spread. Systemic antimicrobial agents alone will not adequately treat endogenous endophthalmitis. Intravitreal antimicrobial therapy is warranted, and vitrectomy is indicated in cases of severe vision loss or progression of infection despite antimicrobial therapy. In this case, further imaging identified paraspinal muscle abscesses and mitral valve endocarditis. Treatment with intravitreal antimicrobial agents and an 8-week course of intravenous cefazolin was initiated. A vitrectomy was not performed owing to the relatively late clinical presentation. At a 2-month follow-up visit, the patient’s vision had not improved.