A case of Listeria monocytogenes endophthalmitis with recurrent inflammation and novel management

Abstract

BackgroundListeria monocytogenes is a rare cause of endogenous endophthalmitis. In the limited number of reported Listeria endophthalmitis cases, visual acuity outcomes have been very poor.FindingsHere, we report a case of Listeria endophthalmitis that was complicated by recurrent inflammation. The patient required treatment with both intravitreal and long-term systemic antibiotics. An anterior chamber washout was necessary for the patient to regain 20/20 visual acuity.ConclusionsThis case highlights the importance of considering Listeria early in the disease course, as it has low sensitivity to standard empiric antibiotic therapy. It also stresses the importance of addressing damaging inflammation in infectious conditions.

Listeria Infections of the Eye

“…In one report, however, eye infection with Listeria started with conjunctivitis and resulted finally in endophthalmitis (40). Recurrent heavy inflammatory reactions of the conjunctiva and the anterior chamber were observed after unilateral Listeria infection of the eye in an otherwise immunocompetent patient (41).…”

“…In severe cases, the anterior chamber of the eye is afflicted, so that a hypopyon typically develops. This complication may be due to a heavy immune reaction leading to elevated levels of inflammatory mediators (41).…”

“…Therefore, in a few cases the eye can be the only manifestation of a presumably hematogenous distribution without any identified extraocular septic foci (4, 39, 53–54–55–56–57–58–59). If this happens in patients with no underlying disease or state of immunosuppression (54, 60), it will finally remain obscure in practice whether the eye was involved during an endogenous or an exogenous mode of infection (41).…”

Listeria monocytogenes, a rare cause of endophthalmitis

“…Most of patients who present endophthalmitis due to L. monocytogenes have poor visual acuity results even with adequate antibiotic treatment, especially due to a delay in the diagnosis since it is not a frequent pathology [1]. Because of Listeria monocytogenes, a rare cause of endophthalmitis Sir,…”

“…Listeria monocytogenes is a ubiquitous Gram-positive rod that is found in food and is responsible for gastrointestinal infections due to the consumption of unpasteurized dairy products or contaminated meat and vegetables. Rarely, it produces invasive disease that primarily affects immunosuppressed patients, chronic diseases, intravenous drug use, malignancies, the elderly and pregnant women; mainly causing bacteremia and meningitis [1][2][3]. L. monocytogenes is a rare and serious cause of endophthalmitis, which can lead to vision loss [3].…”