Diffuse Retinal Vasculitis in Citrobacter koseri Traumatic Endophthalmitis With Intraocular Foreign Body

Abstract

A 43-year-old man suffered from corneal perforation by a metal fragment in the right eye while using a lawn mower. At presentation, his visual acuity was hand motion in the right eye and 20/20 in the left eye. Anterior segment demonstrated a 3.5-mm full-thickness corneal laceration, fibrin over pupillary margin, and traumatic cataract. Computed tomography demonstrated a high density of metallic fragment in the vitreous cavity. Traumatic endophthalmitis with intraocular foreign body (IOFB) was diagnosed, and emergent operation was immediately performed after 12 hours of ocular injury. Diffuse retinal vasculitis, vitreous opacity, and an intraocular metal fragment were found during vitrectomy ( Fig. 1). At the end of surgery, intravitreal injections of vancomycin (1 mg/0.1 mL) and amikacin (0.2 mg/0.1 mL) were performed. Cultures of vitreous fluid revealed gramnegative bacilli identified as Citrobacter koseri, which was sensitive to amikacin and ceftazidime. Because of persistent vitreous inflammation, intravitreal injections of amikacin and dexamethasone were performed on day 4. Three months later, the best-corrected visual acuity was 20/60. Fundus examination showed the resolution of retinal vasculitis (Fig. 2).Infectious endophthalmitis is an uncommon but serious ocular infection often resulting in severe vision loss. Retinal vasculitis is one of the most common signs of endophthalmitis; however, it has been rarely reported in the literature. 1 Citrobacter species are gram-negative nonspore-forming rods and are isolated from water, soil, food, and the intestinal tracts of humans and animals. Previously published studies concerning endophthalmitis caused by Citrobacter species are limited to case reports. 2 We report a case of diffuse retinal vasculitis in C. koseri posttraumatic endophthalmitis with IOFB. Patients should be made aware of the need to seek surgical management after ocular penetrating injury with IOFB. Prompt management may save the eye and achieve a favorable visual outcome. REFERENCES1. Packer AJ, Weingeist TA, Abrams GW. Retinal periphlebitis as an early sign of bacterial endophthalmitis. Am J Ophthalmol. 1983;96:66 -71. 2. Insler MS, Kook MS, Mani H, Peyman GA. Citrobacter diversus endophthalmitis following penetrating keratoplasty. Am J Ophthalmol.Figure 1. Diffuse retinal vascular sheathening (vasculitis), retinal hemorrhage, and peripapillary hemorrhage were showed in the posterior fundus.Figure 2. Fundus photograph showed the resolution of retinal vasculitis.

Retinal vasculitis following pars plana vitrectomy for retained lens material

“…Previous reports concerning retinal vasculitis all had moderate to severe anterior and posterior segment involvement at the initial presentation, which could orient the practitioner towards a possible infectious endophthalmitis. [3][4][5] As there was no ocular pain, no anterior chamber or vitreous inflammation, we diagnosed these cases as retinal vasculitis. We then searched for the common cause of retinal vasculitis in these two patients.…”

“…Pars plana vitrectomy (PPV) is an effective treatment with late complications such as epimacular proliferation, retinal detachment and cystoid macular oedema 1,2 . Though retinal vasculitis has been reported as the early sign of post‐operative endophthalmitis following uneventful cataract surgery and trauma from a penetrating foreign body, there is only one documented report of retinal vasculitis with lens‐induced uveitis with pars plana vitrectomy for retained lens fragments 3–6 . We describe two consecutive cases of retinal vasculitis in patients who underwent PPV for retained lens fragments and dropped nucleus.…”

Endophthalmitis Rate after Open-globe Injuries in the Area of the City of Van

“…Nadir görülen etkenlerden olarak E. coli, Psödomonas, Staph. gallinarium ve Citrobacter koseri mikroorganizmalar›n›n etken oldu¤u vakalar da bildirilmifltir (15)(16)(17) Bizim çal›flma-m›zda 21 kültürden sadece yedisinde üreme görüldü ve en s›k üretilen etken dört kültür ile S. pyogenes idi.…”