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Endogenous aeromonas hydrophila endophthalmitis in an immunocompromised patient.

Sohn HJ, Nam DH, Kim YS, Paik HJ - Korean J Ophthalmol (2007)

Bottom Line: Under the impression of endogenous bacterial endophthalmitis, immediate intraocular cultures and intravitreal antibiotic injections were performed, but the anterior chamber reaction, and the ultrasonogram findings were deteriorated.Evisceration was undertaken because of extrusion of the intraocular contents, and Aeromonas hydrophila was isolated by intraocular culture.Endogenous endophthalmitis due to Aeromonas hydrophila is rare, but has a rapid clinical course and a poor prognosis, despite of prompt diagnosis and management.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology, Gachon University Gil Medical Center, Namdong-gu, Incheon, Korea.

ABSTRACT

Purpose: To report a case of endogenous endophthalmitis due to Aeromonas hydrophila in a patient with distal common bile duct carcinoma and biliary sepsis.

Methods: A 72-year-old woman with distal common bile duct carcinoma, obstructive jaundice, diabetes mellitus, and hypertension had a 1-day history of blurred vision, redness, and eye discharges in the right eye. An ophthalmic examination showed no light perception vision, increased intraocular pressure, severe corneal edema, severe anterior chamber reaction, exudative membranes on the anterior lens surface, and severe vitreal reaction. There was no ocular history of trauma, infection, or surgery in either eye.

Results: Under the impression of endogenous bacterial endophthalmitis, immediate intraocular cultures and intravitreal antibiotic injections were performed, but the anterior chamber reaction, and the ultrasonogram findings were deteriorated. Evisceration was undertaken because of extrusion of the intraocular contents, and Aeromonas hydrophila was isolated by intraocular culture.

Conclusions: Endogenous endophthalmitis due to Aeromonas hydrophila is rare, but has a rapid clinical course and a poor prognosis, despite of prompt diagnosis and management.

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Related in: MedlinePlus

A. Slit-lamp photograph on the day 2 after intravitreal injections: Totally opaque cornea and inferior protrusion of the eyeball.B. B-scan ultrasonograph on the day 2 after intravitreal injections: Increased and condensed vitreous opacities.
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Figure 2: A. Slit-lamp photograph on the day 2 after intravitreal injections: Totally opaque cornea and inferior protrusion of the eyeball.B. B-scan ultrasonograph on the day 2 after intravitreal injections: Increased and condensed vitreous opacities.

Mentions: A 72-year-old woman with distal common bile duct carcinoma, obstructive jaundice, diabetes mellitus, and hypertension was admitted to our gastroenterology department. Two days after admission, ophthalmic consultation was sought to evaluate diabetic retinopathy. At initial examination, best-corrected visual acuity was 20/50 in both eyes with incipient cataract, but no sign of diabetic retinopathy. Moreover, there was no ocular history of trauma, infection, or surgery in either eye. Three days later, on day 5 after admission, the patient reported a 1-day history of blurred vision, redness, and eye discharge in the right eye. The patient was alert enough to have promptly reported her symptoms. Ophthalmic examination of the right eye showed a best-corrected visual acuity of no light perception, severe chemosis and injection of conjunctiva, and corneal haziness. Slit-lamp examination revealed an increased intraocular pressure of 30 mmHg, severe corneal edema, a shallow anterior chamber, severe anterior chamber reaction (many cells, flare, and RBCs), exudative membranes on the anterior lens surface, and a mid-dilated pupil (Fig. 1A). Fundus examination was obscured by severe vitreal reaction. A B-scan ultrasonogram showed moderate vitreous opacities (Fig. 1B). Ophthalmic examination of the left eye was unremarkable. Under the impression of endogenous bacterial endophthalmitis, immediate intraocular cultures (anterior chamber paracentesis 0.2 ml, vitreous needle aspiration 0.3 ml) and intravitreal antibiotic injections (vancomycin 1 mg/0.1 ml, ceftazidime 2 mg/0.1 ml) were performed with subsequent intravenous antibiotic therapy (Meropenem 2 g per day). Because of corneal haziness, it was impossible to treat the endophthalmitis surgically. Despite the intravitreal injections the anterior chamber reaction and ultrasonogram findings deteriorated, with inferior protrusion of the globe (Fig. 2). Intraocular Gram staining revealed 2+ gram-negative rods and 4+ Aeromonas hydrophila sensitive to ceftazidime by intraocular culture. Culture results from urine and bile juice were positive for Acinobacter Iwoffi/baumannii and Enterobacter aerogenes, respectively. However, blood culture results were negative for Aeromonas hydrophila. On day 8 after admission, percutaneous transhepatic biliary drainage was done to control total bilirubin, and on day 6 after intravitreal injections, limbus perforation occurred with extrusion of the intraocular contents (Fig. 3). Evisceration and Medpor® (porous polyethylene, Porex Surgical, College Park, GA, U.S.A.) sphere implantation was done. On day 40 after admission, the patient was discharged from hospital with controlled jaundice, when her predicted survival was less than one year.


Endogenous aeromonas hydrophila endophthalmitis in an immunocompromised patient.

Sohn HJ, Nam DH, Kim YS, Paik HJ - Korean J Ophthalmol (2007)

A. Slit-lamp photograph on the day 2 after intravitreal injections: Totally opaque cornea and inferior protrusion of the eyeball.B. B-scan ultrasonograph on the day 2 after intravitreal injections: Increased and condensed vitreous opacities.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2629690&req=5

Figure 2: A. Slit-lamp photograph on the day 2 after intravitreal injections: Totally opaque cornea and inferior protrusion of the eyeball.B. B-scan ultrasonograph on the day 2 after intravitreal injections: Increased and condensed vitreous opacities.
Mentions: A 72-year-old woman with distal common bile duct carcinoma, obstructive jaundice, diabetes mellitus, and hypertension was admitted to our gastroenterology department. Two days after admission, ophthalmic consultation was sought to evaluate diabetic retinopathy. At initial examination, best-corrected visual acuity was 20/50 in both eyes with incipient cataract, but no sign of diabetic retinopathy. Moreover, there was no ocular history of trauma, infection, or surgery in either eye. Three days later, on day 5 after admission, the patient reported a 1-day history of blurred vision, redness, and eye discharge in the right eye. The patient was alert enough to have promptly reported her symptoms. Ophthalmic examination of the right eye showed a best-corrected visual acuity of no light perception, severe chemosis and injection of conjunctiva, and corneal haziness. Slit-lamp examination revealed an increased intraocular pressure of 30 mmHg, severe corneal edema, a shallow anterior chamber, severe anterior chamber reaction (many cells, flare, and RBCs), exudative membranes on the anterior lens surface, and a mid-dilated pupil (Fig. 1A). Fundus examination was obscured by severe vitreal reaction. A B-scan ultrasonogram showed moderate vitreous opacities (Fig. 1B). Ophthalmic examination of the left eye was unremarkable. Under the impression of endogenous bacterial endophthalmitis, immediate intraocular cultures (anterior chamber paracentesis 0.2 ml, vitreous needle aspiration 0.3 ml) and intravitreal antibiotic injections (vancomycin 1 mg/0.1 ml, ceftazidime 2 mg/0.1 ml) were performed with subsequent intravenous antibiotic therapy (Meropenem 2 g per day). Because of corneal haziness, it was impossible to treat the endophthalmitis surgically. Despite the intravitreal injections the anterior chamber reaction and ultrasonogram findings deteriorated, with inferior protrusion of the globe (Fig. 2). Intraocular Gram staining revealed 2+ gram-negative rods and 4+ Aeromonas hydrophila sensitive to ceftazidime by intraocular culture. Culture results from urine and bile juice were positive for Acinobacter Iwoffi/baumannii and Enterobacter aerogenes, respectively. However, blood culture results were negative for Aeromonas hydrophila. On day 8 after admission, percutaneous transhepatic biliary drainage was done to control total bilirubin, and on day 6 after intravitreal injections, limbus perforation occurred with extrusion of the intraocular contents (Fig. 3). Evisceration and Medpor® (porous polyethylene, Porex Surgical, College Park, GA, U.S.A.) sphere implantation was done. On day 40 after admission, the patient was discharged from hospital with controlled jaundice, when her predicted survival was less than one year.

Bottom Line: Under the impression of endogenous bacterial endophthalmitis, immediate intraocular cultures and intravitreal antibiotic injections were performed, but the anterior chamber reaction, and the ultrasonogram findings were deteriorated.Evisceration was undertaken because of extrusion of the intraocular contents, and Aeromonas hydrophila was isolated by intraocular culture.Endogenous endophthalmitis due to Aeromonas hydrophila is rare, but has a rapid clinical course and a poor prognosis, despite of prompt diagnosis and management.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology, Gachon University Gil Medical Center, Namdong-gu, Incheon, Korea.

ABSTRACT

Purpose: To report a case of endogenous endophthalmitis due to Aeromonas hydrophila in a patient with distal common bile duct carcinoma and biliary sepsis.

Methods: A 72-year-old woman with distal common bile duct carcinoma, obstructive jaundice, diabetes mellitus, and hypertension had a 1-day history of blurred vision, redness, and eye discharges in the right eye. An ophthalmic examination showed no light perception vision, increased intraocular pressure, severe corneal edema, severe anterior chamber reaction, exudative membranes on the anterior lens surface, and severe vitreal reaction. There was no ocular history of trauma, infection, or surgery in either eye.

Results: Under the impression of endogenous bacterial endophthalmitis, immediate intraocular cultures and intravitreal antibiotic injections were performed, but the anterior chamber reaction, and the ultrasonogram findings were deteriorated. Evisceration was undertaken because of extrusion of the intraocular contents, and Aeromonas hydrophila was isolated by intraocular culture.

Conclusions: Endogenous endophthalmitis due to Aeromonas hydrophila is rare, but has a rapid clinical course and a poor prognosis, despite of prompt diagnosis and management.

Show MeSH
Related in: MedlinePlus