A rare case of peripartum endogenous bacterial endophthalmitis

Abstract

We describe the case of a healthy, pregnant female who developed endogenous endophthalmitis at the time of delivery, and discuss the possible mechanism of infection and the management of this case. A 26-year-old Asian woman presented with a 3-week history of visual deterioration and pain in the right eye. There was no history of ocular trauma or surgery. The ocular symptoms developed one day after vaginal delivery of a healthy baby. The pregnancy had been uncomplicated until premature rupture of membranes one week prior to delivery. Right visual acuity was light perception. There was marked right anterior chamber activity with a hypopyon and fibrin. A B-scan ultrasound showed dense vitritis. Examination of the left eye was normal. Blood tests and a chest X-ray were normal. A vitreous tap was performed and bacterial culture grew Sphingomonas paucimobilis. Intravitreal antibiotics were injected (amikacin 0.4 mg/0.1 ml and vancomycin 2.0 mg/0.1 ml) and the patient was treated with oral moxifloxacin and corticosteroids. Right visual acuity improved to 6/9. This case highlights the need for clinicians to have a high level of awareness of endogenous bacterial endophthalmitis (a rare, potentially sight-threatening condition) in any patient with a painful eye or visual deterioration in the peripartum period, particularly if associated with complications such as premature rupture of membranes or perineal laceration.

Composition and Diversity of Bacterial Community on the Ocular Surface of Patients With Meibomian Gland Dysfunction

“…46 Moreover, several clinical cases of endophthalmitis caused by Sphingomonas were reported. [47][48][49][50] Although the specific role that these bacteria play in MGD remains unclear, their proliferation in the conjunctival sac of patients with MGD requires more attention. Clinicians should attach importance to preoperative management to assure the reduction of pathogens on the ocular surface before any ocular surgical procedure for MGD.…”

FulminantSphingomonas paucimobiliskeratitis: case study and review of literature

“…Until, reported ocular infections caused by the organism including panophthalmitis, endophthalmitis and keratitis were seen either in peripartum phase or occurred after cataract surgery, penetrating ocular trauma or contact lens use (table 1). 6–15 However, in our patient, microbial keratitis was spontaneous in onset and no such risk factor could be identified. Adams reported a case of recurrent acute endophthalmitis postcataract surgery caused by the same organism that responded well to vitrectomy 6.…”

“…The same mechanism may also explain graft infection in our case. However, what remains unexplained is the constant unresponsiveness of the organism to aggressive medical and surgical management as in all the previously reported cases of ocular infections caused by S. paucimobilis , the infection responded well to commonly used antibacterial agents 4 6–17. Nevertheless, antibiotics resistant cases and cases requiring evisceration have also been reported by others 6 7 9 12.…”

“…Sphingomonas paucimobilis , previously known as Pseudomonas paucimoblis, is a type of gram-negative aerobic bacillus known to cause various systemic and ocular infections 2–17. It is usually associated with endophthalmitis and panophthalmitis and can also cause microbial keratitis.…”

Orbital Cellulitis with Endogenous Panophthalmitis Caused by Methicillin-Sensitive <i>Staphylococcus aureus</i> in Pregnancy

“…This down-regulation of the cell-mediated immunity that occurs in order to permit fetal retention also interferes with resistance to some infections. Peripartum endogenous endophthalmitis has been documented previously; majority of these cases were postpartum or following a terminative procedure like abortion and very few cases developed ocular infections during pregnancy (4). As highlighted by Sahu et al, drugs that are administered during pregnancy may have many short-term and long-term effects on the unborn child, which remain unknown.…”