Images in Clinical Medicine
Endogenous Endophthalmitis
N Engl J Med 2007; 357:163July 12, 2007
- Article
A 57-year-old man who had end-stage renal disease was admitted to the hospital because of infection of a left-upper-extremity fistula. Vancomycin was started empirically, and blood cultures grew methicillin-resistant Staphylococcus aureus. Several days after admission, he reported new pain, redness, and decreased visual acuity in his right eye. Visual acuity was assessed by the ability to count the number of fingers held up by the examiner at a distance of 10 in. (25 cm). Visual inspection revealed marked subconjunctival hemorrhage (short arrow) and a small hypopyon (long arrow). Ophthalmologic examination showed vitreous debris and retinal traction, which were consistent with endogenous endophthalmitis. A bacterial culture of the vitreous sample did not grow methicillin-resistant S. aureus, but the patient had been taking antibiotics for a few days. Endogenous endophthalmitis is a potentially sight-threatening infection of the eye that usually arises from hematogenous spread. Prompt recognition and the initiation of early antimicrobial therapy are essential, although the prognosis for the eye is poor. The patient was given both intravenous vancomycin and intravitreous vancomycin and ceftazidime. At the last known follow-up, approximately 8 months after the initial event, his pain had improved but his visual acuity had decreased to hand-motion vision, and nearly complete retinal detachment had developed.
Elizabeth H. Burgess, M.D.
Luis Fernando Mora Vieira, M.D.
Emory University School of Medicine, Atlanta, GA 30333
luismora71@hotmail.com - Citing Articles (1)
Citing Articles
1
Vincent Ho, Lawrence Y Ho, Tushar M Ranchod, Kimberly A Drenser, George A Williams, Bruce R Garretson. (2011) ENDOGENOUS METHICILLIN-RESISTANT STAPHYLOCOCCUS AUREUS ENDOPHTHALMITIS. Retina 31:3, 596-601
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