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

Alkatan HM, Al-Dhibi HA, Edward DP, Al-Rajhi AA - Middle East Afr J Ophthalmol (2014 Jan-Mar)

Bottom Line: Listeria monocytogenes is an aerobic, motile, gram positive bacillus recognized as an intercellular pathogen in human where it most frequently affects neonates, pregnant women, elderly patients, and immunosuppressed individuals as well as healthy persons.Diagnosis of ocular listeriosis was confirmed by positive culture of anterior chamber (AC) aspirate with identification of the above organism.His visual outcome was satisfactory with good preserved vision.

View Article: PubMed Central - PubMed

Affiliation: Department of Pathology and Laboratory Medicine, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia.

ABSTRACT

Purpose: Listeria monocytogenes is an aerobic, motile, gram positive bacillus recognized as an intercellular pathogen in human where it most frequently affects neonates, pregnant women, elderly patients, and immunosuppressed individuals as well as healthy persons. Ocular listeriosis is rare, most frequently in the form of conjunctivitis, but has been also shown to cause rarely endophthalmitis with pigmented hypopyon and elevated intraocular pressure such as in our case.

Materials and methods: We are reporting one immunocompetent patient presenting with dark hypopyon following laser refractive procedure. His clinical findings, investigations, and further management are all described with relevant literature review of similar cases.

Results: Diagnosis of ocular listeriosis was confirmed by positive culture of anterior chamber (AC) aspirate with identification of the above organism. His visual outcome was satisfactory with good preserved vision.

Conclusion: We believe that his ocular infection was exogenous and that ophthalmologists should be aware of the causative organisms of colored hypopyon to avoid delayed diagnosis.

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Related in: MedlinePlus

(a) Histologic smear of the aqueous showing the predominant polymorphonuclear leukocytes (hematoxylin and eosin, original magnification ×400). (b) Blood agar plate showing the bacterial colonies with surrounding beta hemolysis. (c) The clinical appearance of the right eye cataract and posterior synechiae. (d) Postoperative slit-lamp photo of his right eye with intraocular lens (IOL) in the capsular bag
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Figure 2: (a) Histologic smear of the aqueous showing the predominant polymorphonuclear leukocytes (hematoxylin and eosin, original magnification ×400). (b) Blood agar plate showing the bacterial colonies with surrounding beta hemolysis. (c) The clinical appearance of the right eye cataract and posterior synechiae. (d) Postoperative slit-lamp photo of his right eye with intraocular lens (IOL) in the capsular bag

Mentions: The smears prepared from his AC washout showed necrotic debris insterspersed with both extra- and intracellular melanin granules. Moderate number of polymorphonuclear leukocytes were also present [Figure 2a]. The Grocott's methenamine silver (GMS), gram, and acid-fast stains were all negative. No malignant cells were seen to suggest a masquerade syndrome. The AC aqueous was sent for polymerase chain reaction (PCR) to rule out infectious etiology including herpetic infection, cytomegalovirus, varicella zoster, tuberculosis, and Chlamydia which were all negative. The aqueous fluid culture proved bacterial growth identified as Listeria monocytogenes in the blood agar plate [Figure 2b] and brain heart infusion (BHI) broth. The organism was sensitive to gentamicin and penicillin G. The culture of the vitreous fluid showed few gram positive bacilli which were not further identified. Valtrex and moxifloxacin were stopped and the patient was given intravenous penicillin G 15 million units every 6 h (following a negative skin test) for 2 weeks and then shifted to oral augmentin 1 g twice daily for another 2 weeks.


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

Alkatan HM, Al-Dhibi HA, Edward DP, Al-Rajhi AA - Middle East Afr J Ophthalmol (2014 Jan-Mar)

(a) Histologic smear of the aqueous showing the predominant polymorphonuclear leukocytes (hematoxylin and eosin, original magnification ×400). (b) Blood agar plate showing the bacterial colonies with surrounding beta hemolysis. (c) The clinical appearance of the right eye cataract and posterior synechiae. (d) Postoperative slit-lamp photo of his right eye with intraocular lens (IOL) in the capsular bag
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3959040&req=5

Figure 2: (a) Histologic smear of the aqueous showing the predominant polymorphonuclear leukocytes (hematoxylin and eosin, original magnification ×400). (b) Blood agar plate showing the bacterial colonies with surrounding beta hemolysis. (c) The clinical appearance of the right eye cataract and posterior synechiae. (d) Postoperative slit-lamp photo of his right eye with intraocular lens (IOL) in the capsular bag
Mentions: The smears prepared from his AC washout showed necrotic debris insterspersed with both extra- and intracellular melanin granules. Moderate number of polymorphonuclear leukocytes were also present [Figure 2a]. The Grocott's methenamine silver (GMS), gram, and acid-fast stains were all negative. No malignant cells were seen to suggest a masquerade syndrome. The AC aqueous was sent for polymerase chain reaction (PCR) to rule out infectious etiology including herpetic infection, cytomegalovirus, varicella zoster, tuberculosis, and Chlamydia which were all negative. The aqueous fluid culture proved bacterial growth identified as Listeria monocytogenes in the blood agar plate [Figure 2b] and brain heart infusion (BHI) broth. The organism was sensitive to gentamicin and penicillin G. The culture of the vitreous fluid showed few gram positive bacilli which were not further identified. Valtrex and moxifloxacin were stopped and the patient was given intravenous penicillin G 15 million units every 6 h (following a negative skin test) for 2 weeks and then shifted to oral augmentin 1 g twice daily for another 2 weeks.

Bottom Line: Listeria monocytogenes is an aerobic, motile, gram positive bacillus recognized as an intercellular pathogen in human where it most frequently affects neonates, pregnant women, elderly patients, and immunosuppressed individuals as well as healthy persons.Diagnosis of ocular listeriosis was confirmed by positive culture of anterior chamber (AC) aspirate with identification of the above organism.His visual outcome was satisfactory with good preserved vision.

View Article: PubMed Central - PubMed

Affiliation: Department of Pathology and Laboratory Medicine, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia.

ABSTRACT

Purpose: Listeria monocytogenes is an aerobic, motile, gram positive bacillus recognized as an intercellular pathogen in human where it most frequently affects neonates, pregnant women, elderly patients, and immunosuppressed individuals as well as healthy persons. Ocular listeriosis is rare, most frequently in the form of conjunctivitis, but has been also shown to cause rarely endophthalmitis with pigmented hypopyon and elevated intraocular pressure such as in our case.

Materials and methods: We are reporting one immunocompetent patient presenting with dark hypopyon following laser refractive procedure. His clinical findings, investigations, and further management are all described with relevant literature review of similar cases.

Results: Diagnosis of ocular listeriosis was confirmed by positive culture of anterior chamber (AC) aspirate with identification of the above organism. His visual outcome was satisfactory with good preserved vision.

Conclusion: We believe that his ocular infection was exogenous and that ophthalmologists should be aware of the causative organisms of colored hypopyon to avoid delayed diagnosis.

Show MeSH
Related in: MedlinePlus