Pink hypopyon: a sign of Serratia marcescens endophthalmitis.

Abstract

Endogenous bacterial endophthalmitis in infants is uncommon. We recently examined and treated an infant who presented with pink hypopyon which followed a Serratia marcescens septicaemia. Culture ofthe aspirate from the anterior chamber showed no red blood cells, and grew Serratia marcescens, which was also isolated from the tip of the child's umbilical artery catheter. The presence of a pink hypopyon in the absence ofhyphaema may suggest the diagnosis of Serratia marcescens endophthalmitis. (BrJ Ophthalmol 1992; 76: Case report After an uneventful pregnancy, a healthy 18-year-old primigravida had an uncomplicated labour and delivered a 2-65 kg full term infant. The neonate required resuscitation after delivery. Apgar scores were 1 at 5 minutes, 3 at 6 minutes, and 5 at 10 minutes. During the first few hours of life, the baby developed convulsions and was treated with 60% oxygen and phenobarbitone. Three days later the infant developed clinical signs of septicaemia and disseminated intravascular coagulopathy. Serratia marcescens was isolated from blood cultures and from the infant's ear, nose, and throat. S marcescens was also cultured from the tip of the child's umbilical artery catheter.Ophthalmic examination disclosed a normal right eye. The left cornea was hazy centrally. A fibrinous exudate was seen in the anterior chamber occluding the pupil and precluding visualisation of the fundus. A pink hypopyon occupied one third of the anterior chamber.

Serratia marcescensendogenous endophthalmitis in an immunocompetent host

“…This organism accounts for 4% of cases of endogenous endophthalmitis 1 2. It can also cause conjunctivitis and keratitis, and systemically it can cause meningitis, otitis media, endocarditis, pneumonitis and septicaemia.…”

“…It can also cause conjunctivitis and keratitis, and systemically it can cause meningitis, otitis media, endocarditis, pneumonitis and septicaemia. It is generally sensitive to quinolones, aminoglycosides and third-generation cephalosporins, although resistance to the latter has been reported 1 3 4. Serratia endophthalmitis, endogenous or otherwise, is associated with poor visual prognosis 5.…”

“…Intense AC reaction precluding a fundal view was cited in most reported cases. Other features include intense purulent discharge and hypopyon, which may be white, dark or pink 1 6. Despite aggressive medical/surgical treatment, the vast majority of patients ultimately lose light perception in the affected eye, requiring either evisceration or enucleation.…”

Pigmented hypopyon in association with Listeria monocytogenes endopthalmitis: An interesting case report following refractive surgery procedure with literature review

“…On the other hand, pink hypopyon has been described in association with two causative organisms. The first is Serratia marcescens , also known as Bacterium prodigiosum because it produces a red pigment which has been a useful marker in bacteremia after dental extractions as well as bacteriuria after urinary tract procedures 13. The second is Klebsiella pneumonia where the authors speculated that the pink hypopyon was caused by severe necrosis similar to the characteristic brick-red or “currant jelly” sputum seen in Klebsiella pneumomia 14…”

Serratia marcescens endophthalmitis secondary to pneumonia

“…S. marcescens is multiresistant Gram-negative bacillus that can produce a red pigment causing a pink hypopyon. 7 To our knowledge, this is the first reported case of S. marcescens pneumonia as a primary source for EE (the lung is the most common site for these pathogens 8 ). Despite appropriate systemic and intravitreal antibiotics, the visual outcome was poor and the patient eventually died.…”