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Cecocentral scotoma as the initial manifestation of subacute bacterial endocarditis.

Strauss DS, Baharestani S, Nemiroff J, Amesur K, Howard D - Clin Ophthalmol (2011)

Bottom Line: A 67-year-old man presented with sudden, painless decreased vision in the left eye.A dilated fundoscopic exam revealed temporal segmental optic disc pallor on the left, and Humphrey visual field testing demonstrated a dense left cecocentral scotoma.When the patient developed fever (103. 9°F) and palpitations, transthoracic echocardiogram revealed valvular vegetations, and contrast CT of the abdomen revealed an abscess in the dome of the liver likely due to an infectious thrombus.

View Article: PubMed Central - PubMed

Affiliation: New York University Langone Medical Center, New York, NY, USA.

ABSTRACT

Introduction: We report a case of a 67-year-old male who presented with a cecocentral scotoma caused by a septic embolus from subacute bacterial endocarditis (SBE).

Methods: A 67-year-old man presented with sudden, painless decreased vision in the left eye. A dilated fundoscopic exam, Humphrey visual field test, transthoracic echocardiogram, abdominal computed tomography (CT), and blood cultures were all performed.

Results: A dilated fundoscopic exam revealed temporal segmental optic disc pallor on the left, and Humphrey visual field testing demonstrated a dense left cecocentral scotoma. When the patient developed fever (103. 9°F) and palpitations, transthoracic echocardiogram revealed valvular vegetations, and contrast CT of the abdomen revealed an abscess in the dome of the liver likely due to an infectious thrombus. Blood cultures grew viridians group streptococci in three separate peripheral collections.

Conclusion: This case illustrates that a sudden cecocentral scotoma may be the initial manifestation of SBE.

No MeSH data available.


Related in: MedlinePlus

Fundus photo showing inferotemporal disc pallor in the left eye.
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f3-opth-5-287: Fundus photo showing inferotemporal disc pallor in the left eye.

Mentions: On serial yearly follow-up examinations almost a decade after the original insult, the patient’s low vision status on the left persists with decreased Snellen vision, reproducible red desaturation, and decreased color plates on that side. Yearly follow-up Humphrey visual field testing has remained unchanged. Follow-up intravenous fluoroscein angiography has remained unremarkable, with recent fundus photos of the left eye (Figure 3) showing inferotemporal disk pallor. Follow-up MRI was not acquired, as the patient’s examination and visual defect remained stable over many years. We postulate that an infectious embolus from endocarditis impeded circulation, causing ischemia and segmental infarction of the left optic nerve and affecting the maculopapillary bundle.


Cecocentral scotoma as the initial manifestation of subacute bacterial endocarditis.

Strauss DS, Baharestani S, Nemiroff J, Amesur K, Howard D - Clin Ophthalmol (2011)

Fundus photo showing inferotemporal disc pallor in the left eye.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3065569&req=5

f3-opth-5-287: Fundus photo showing inferotemporal disc pallor in the left eye.
Mentions: On serial yearly follow-up examinations almost a decade after the original insult, the patient’s low vision status on the left persists with decreased Snellen vision, reproducible red desaturation, and decreased color plates on that side. Yearly follow-up Humphrey visual field testing has remained unchanged. Follow-up intravenous fluoroscein angiography has remained unremarkable, with recent fundus photos of the left eye (Figure 3) showing inferotemporal disk pallor. Follow-up MRI was not acquired, as the patient’s examination and visual defect remained stable over many years. We postulate that an infectious embolus from endocarditis impeded circulation, causing ischemia and segmental infarction of the left optic nerve and affecting the maculopapillary bundle.

Bottom Line: A 67-year-old man presented with sudden, painless decreased vision in the left eye.A dilated fundoscopic exam revealed temporal segmental optic disc pallor on the left, and Humphrey visual field testing demonstrated a dense left cecocentral scotoma.When the patient developed fever (103. 9°F) and palpitations, transthoracic echocardiogram revealed valvular vegetations, and contrast CT of the abdomen revealed an abscess in the dome of the liver likely due to an infectious thrombus.

View Article: PubMed Central - PubMed

Affiliation: New York University Langone Medical Center, New York, NY, USA.

ABSTRACT

Introduction: We report a case of a 67-year-old male who presented with a cecocentral scotoma caused by a septic embolus from subacute bacterial endocarditis (SBE).

Methods: A 67-year-old man presented with sudden, painless decreased vision in the left eye. A dilated fundoscopic exam, Humphrey visual field test, transthoracic echocardiogram, abdominal computed tomography (CT), and blood cultures were all performed.

Results: A dilated fundoscopic exam revealed temporal segmental optic disc pallor on the left, and Humphrey visual field testing demonstrated a dense left cecocentral scotoma. When the patient developed fever (103. 9°F) and palpitations, transthoracic echocardiogram revealed valvular vegetations, and contrast CT of the abdomen revealed an abscess in the dome of the liver likely due to an infectious thrombus. Blood cultures grew viridians group streptococci in three separate peripheral collections.

Conclusion: This case illustrates that a sudden cecocentral scotoma may be the initial manifestation of SBE.

No MeSH data available.


Related in: MedlinePlus