Blindness as an uncommon complication of Streptococcus pneumoniae systemic infection

Excerpt

A 58-year-old man suffering from active smoking and alcoholism was admitted to ICU for pneumococcal meningitis, pneumonia, and endocarditis. Three blood cultures showed the presence of Streptococcus pneumoniae. The patient was diagnosed with Austrian syndrome, which is a triad consisting of pneumonia, endocarditis, and meningitis, caused by S. pneumonia. He was consistently treated with cefotaxime 300 mg/kg/day. At day 3, fever was completely resolved, but the patient complained of unilateral decreased visual acuity with a red and painful right eye. Endogenous endophthalmitis was diagnosed by a fundus oculi (Fig. 1), showing bilateral chorioretinitis and hyalitis involving predominantly the right eye. Hyalitis was evidenced by the overall blurred aspect of the fundus, while the signs of chorioretinitis included whitish cloudy infiltrates of the retina as well as intraretinal hemorrhagic foci. The patient was treated by intravitreal injection of vancomycin and ceftazidime. The evolution was favorable concerning the systemic infection, but unfortunately at the price of a decrease of bilateral visual acuity.

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