Severe Endogenous Endophthalmitis with Panophthalmitis-Lessons to Learn
- Author:
TEO BH
1
Author Information
1. Department of Ophthalmology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, 56000 Cheras, Kuala Lumpur, Malaysia.
- Collective Name:TEO BH; SAFINAZ MK; UMI KALTHUM MN; WAN HASLINA WAH
- Publication Type:Journal Article
- Keywords:
abscess;
choroid;
endophthalmitis;
panopthalmitis
- From:Medicine and Health
2019;14(1):244-251
- CountryMalaysia
- Language:English
-
Abstract:
Endogenous endophthalmitis is a devastating intraocular infection. Finding the
primary infection and directed treatment is life-saving. We describe a 47-year-old
man, with uncontrolled diabetes mellitus, who presented with two weeks history
of progressive reduced vision and redness of the left eye (LE). He was generally
unwell since a month, previously. Examination showed relative afferent pupillary
defect (RAPD) in the affected eye and visual acuity was hand movement. There was
moderate anterior chamber and vitreous reaction. Fundus examination showed a
huge dome-shaped choroidal mass covering the entire macula. Diagnosis of severe
endogenous endophthalmitis was made, with isolation of Enterobacter sp. from
his blood culture. Meanwhile, he also had elevated inflammatory markers with
presence of leucocytosis, neutrophilia and elevated erythrocyte sedimentation rate
(ESR) as well as C-reactive protein (CRP). Vitreous tap and aqueous tap had no
growth, He improved with combination of intravitreal and systemic antibiotic, as
shown by the resolved fever and reduced inflammatory markers but progressive
inflammation occluded the fundus details and the LE vision eventually became
no projection of light despite treatment. Subsequently, he developed rubeotic
glaucoma and was treated conservatively because the LE was painless with
poor vision. The repeated blood culture and urine was normal. In conclusion,
endogenous endophthalmitis with eventual panophthalmitis is difficult to treat and
has very poor visual prognosis. Our case highlights the challenges faced in the
management of vision-threatening endophthalmitis and panophthalmitis in this
patient.
- Full text:12.2019my0128.pdf
