Rare metastatic seeding: endogenous endophtalmitis in Staphylococcus aureus sepsis

Excerpt

A 73-year old woman was referred to our intensive care unit (ICU) for a Staphylococcus aureus sepsis with ongoing bacteremia, raising the suspicion of endocarditis, which had been treated with intravenous flucloxacillin. During admission, she developed soreness and an impaired vision of her right eye. Examination showed an accumulation of pus in the anterior eye chamber, also called a hypopyon. In addition, there was a complete corneal abrasion, chemosis (swelling of the conjunctiva, posterior synechiae (iris adhering to the lens), and a cloudy cornea (Fig. 1). The intraocular pressure was 46 mmHg and visual acuity was markedly decreased. Ultrasound showed many vitreous hyperintensities and the diagnosis endogenous endophthalmitis was made (Fig. 2). An ophthalmologist performed a bed-side aspirate of aqueous humour, to alleviate the intraocular pressure, upon which the hypopyon was more visible (Fig. 3). Subsequently, an intravitreal injection of vancomycin and ceftazidime was performed. Endocarditis was excluded by transesophageal echocardiography. An MRI revealed cervical spondylodiscitis without signs of paravertebral abscesses. After treatment with intravenous antibiotics for 6 weeks, she regained some vision, but her eye remained painful.

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