Antibiotic‐induced endotoxemia in a patient with endogenous endophthalmitis

Abstract

ABSTRACT.Purpose: The aim of the study is to describe a case of suspected endotoxininduced uveitis associated with septic endogenous endophthalmitis followed by antibiotic-induced endotoxemia. Methods: The human leukocyte antigen (HLA) typing of peripheral leukocytes was studied by lymphocytotoxicity technique. Histological and immunohistochemical studies of paraffin embedded specimen were conducted. Results: Findings of HLA typing revealed positive reaction for B 51, Cw 3, DR 8, DR 11, DQ 3. The vitreous body of an eviscerated eye was occupied by the non-specific granulomatous tissue, composed of fibroblast, plasma cells, and Sudan black staining positive foamy cells, including melaniferous phagocytes, identified as CD 68 positive macrophage. Conclusion: It is suggested that antibiotic-induced endotoxemia of a patient with septic endogenous endophthalmitis produced endotoxin-induced uveitis under an upregulation of HLA and endotoxin activated macrophages may release cytokines, followed by fibrin formation and subsequent granuloma.Key words: Penicillin-binding proteins -endotoxemia -imipenem/cilastatin -septic endogenous endophthalmitis -liver abscess -endotoxin-induced uveitis -intravitreal granuloma.Acta Ophthalmol. Scand. 1999: 77: 110-113 Copyright C Acta Ophthalmol Scand 1999. ISSN 1395-3907 I t is described that systemic or local injection of endotoxin, the lipopolysaccharide (LPS) constituents of gram-negative bacterial outer membranes, will induce inflammation in several organs including eyes (Forrester et al. 1980;Rosenbaum et al. 1980). This inflammatory process characterized by an acute anterior uveitis is described as endotoxininduced uveitis (EIU). EIU in various kinds of animals has been established as an experimental model for human uveitis associated with gram-negative bacterial infection, such as ankylosing spondylitis, acute anterior uveitis and Reiter's syndrome. A clinical feature of EIU is an increase in systemic vascular permeability under an upregulation of major histocompatibility complex class II antigen expression on ocular tissue (Forrester et al. 1980;Rosenbaum et al. 1980). This report describes a case of suspected endotoxin-induced uveitis associated with septic endogenous endophthalmitis followed by antibiotic-induced endotoxemia. Case reportA 68-year-old woman was admitted because of an acute endogenous endophthalmitis on the day of the initial observation, although 9 days after the onset.Visual acuity was CF at 1 ft in her right eye, and 0.6 (1.2 Xπ0.75 DΩcyl-1.50 D180ae) in the left. Ocular sonographic examinations revealed shallow anterior chamber, vitreous opacity, abnormal shadow around the optic nerve, intraorbital opacification and thickening of the posterior eyeball, however, no signs of the intraocular and orbital shadow of a foreign body or tumor were detected. A CT scan showed thickening of left cornea, globe wall and extraocular muscles, and inflammatory changes, such as opacities of intraorbital lipids. Laboratory data showed an increase of serum transaminases, g-g...