An unusual case of recurrent endogenous Klebsiella endophthalmitis

Abstract

patient with high BP and unilateral acute-angle closure glaucoma without any other end-organ damage. Case reportA 22-year-old man presented with severe pain in the left eye without any significant past ocular history. The right eye examination was within normal limits and the left eye had visual acuity and intraocular pressure (IOP) of 20/400 and 55 mm Hg, respectively. The refractive error was plano in the right and À3.00 in the left eyes. Anterior chamber of the left eye was significantly shallower and gonioscopy revealed Shaffer grade 4 (OD) and 0 (OS). Fundoscopy showed optic nerve head swelling, soft exudates, generalized narrowing of arteries, and venous engorgement (Figure 1). On the basis of these findings, we checked BP and found it to be 250/160 mm Hg. There were no signs or symptoms of hypertensive encephalopathy and the brain MRI was normal. The patient was admitted for intravenous anti-hypertensive medications. Because of the high BP, mannitol could not be administered and the IOP was lowered to 28 mm Hg using intravenous lidocaine (0.8 mg/kg) and ocular massage. 3 Although fundoscopy showed no choroidal detachment, ocular sonography revealed choroidal thickening and choroidal effusion (Figure 2). Peripheral iridoplasty was carried out and systemic and topical steroid, topical anti-glaucoma, and cycloplegic medications were started.

Endogenous endophthalmitis: diagnosis, management, and prognosis

“…The first case of bacterial EE has been published in 1856 [ 12 ]. Subsequently, a major review including approximately 335 cases of bacterial EE was published in 2003 [ 11 ], and the authors have recently updated their initial data by accommodating further reports [ 13 ].…”

“…Treatment is first initiated with empirical intravitreal antibiotics that provide a cover for both gram-positive and gram-negative organisms, when the etiology is unknown. These include vancomycin 1 mg/0.1 ml plus either ceftazidime 2.25 mg/0.1 ml or amikacin 0.4 mg/0.1 ml [ 12 , 26 , 44 ]. For gram-positive infections, vancomycin is the primary drug used because of emergence of many cases of methicillin-resistant organisms [ 28 ].…”

Possible Relation between Lack of Posterior Vitreous Detachment and Severe Endogenous Endophthalmitis

“…In the case of phakic eyes, lens extraction is conducted simultaneously, and in the case of eyes with implanted intraocular lens, extraction of the intraocular lens should be considered as the situation demands. In addition, frequent instillation of ceftazidime and vancomycin eye drops after surgery is an accepted treatment for bacterial endophthalmitis [ 6 , 7 ] and should be started as soon as possible after operation.…”

“…The predisposing risk factors for metastatic endogenous endophthalmitis include urinary tract infection, diabetes, HIV infection, intravenous hyperalimentation, liver abscess, and infectious endocarditis, while long-term hospitalization that has increased with the progression of population aging is also an important risk factor [ 5 , 6 , 8 , 9 ]. Furthermore, the association of posterior vitreous detachment (PVD) with retinal disease has attracted attention, accompanying the advent of optical coherence tomography [ 10 , 11 ].…”

Intravitreal Therapy of Endogenous Endophthalmitis due to Urosepsis – A Case Report

“…Endogénna bakteriálna endoftalmitída (EBE) je zriedkavý, zrak ohrozujúci akútny stav, vyskytujúci sa vo väčšine prípadov so systémovou sepsou. Kazuistika s EBE bola prvýkrát publikovaná už v roku 1856 [40], najväčší súbor pacien-tov s EBE -342 pacientov, bol publikovaný v roku 2014 [15]. Fokusy primárnej infekcie sa nachádzajú najčastejšie v pľúcach, pečeni, na endokarde, v mäkkých tkanivách a v močovom trakte.…”