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Severe endogenous endophthalmitis with panophthalmitis-lessons to learn

Endogenous endophthalmitis is a devastating intraocular infection. Finding the primary infection and directed treatment is life-saving. We describe a 47-year-old man, with uncontrolled diabetes mellitus, who presented with two weeks history of progressive reduced vision and redness of the left eye (...

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Main Authors: Teo, BH, Safinaz Mohd Khialdin,, Umi Kalthum MN,, Wan Haslina WAH,
Format: Article
Language:English
Published: Pusat Perubatan Universiti Kebangsaan Malaysia 2019
Online Access:http://journalarticle.ukm.my/15232/1/24_ms0270_pdf_12740.pdf
http://journalarticle.ukm.my/15232/
http://www.medicineandhealthukm.com/toc/14/1
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spelling my-ukm.journal.152322020-09-21T07:08:11Z http://journalarticle.ukm.my/15232/ Severe endogenous endophthalmitis with panophthalmitis-lessons to learn Teo, BH Safinaz Mohd Khialdin, Umi Kalthum MN, Wan Haslina WAH, Endogenous endophthalmitis is a devastating intraocular infection. Finding the primary infection and directed treatment is life-saving. We describe a 47-year-old man, with uncontrolled diabetes mellitus, who presented with two weeks history of progressive reduced vision and redness of the left eye (LE). He was generally unwell since a month, previously. Examination showed relative afferent pupillary defect (RAPD) in the affected eye and visual acuity was hand movement. There was moderate anterior chamber and vitreous reaction. Fundus examination showed a huge dome-shaped choroidal mass covering the entire macula. Diagnosis of severe endogenous endophthalmitis was made, with isolation of Enterobacter sp. from his blood culture. Meanwhile, he also had elevated inflammatory markers with presence of leucocytosis, neutrophilia and elevated erythrocyte sedimentation rate (ESR) as well as C-reactive protein (CRP). Vitreous tap and aqueous tap had no growth, He improved with combination of intravitreal and systemic antibiotic, as shown by the resolved fever and reduced inflammatory markers but progressive inflammation occluded the fundus details and the LE vision eventually became no projection of light despite treatment. Subsequently, he developed rubeotic glaucoma and was treated conservatively because the LE was painless with poor vision. The repeated blood culture and urine was normal. In conclusion, endogenous endophthalmitis with eventual panophthalmitis is difficult to treat and has very poor visual prognosis. Our case highlights the challenges faced in the management of vision-threatening endophthalmitis and panophthalmitis in this patient. Pusat Perubatan Universiti Kebangsaan Malaysia 2019 Article PeerReviewed application/pdf en http://journalarticle.ukm.my/15232/1/24_ms0270_pdf_12740.pdf Teo, BH and Safinaz Mohd Khialdin, and Umi Kalthum MN, and Wan Haslina WAH, (2019) Severe endogenous endophthalmitis with panophthalmitis-lessons to learn. Medicine & Health, 14 (1). pp. 244-251. ISSN 2289-5728 http://www.medicineandhealthukm.com/toc/14/1
institution Universiti Kebangsaan Malaysia
building Tun Sri Lanang Library
collection Institutional Repository
continent Asia
country Malaysia
content_provider Universiti Kebangsaan Malaysia
content_source UKM Journal Article Repository
url_provider http://journalarticle.ukm.my/
language English
description Endogenous endophthalmitis is a devastating intraocular infection. Finding the primary infection and directed treatment is life-saving. We describe a 47-year-old man, with uncontrolled diabetes mellitus, who presented with two weeks history of progressive reduced vision and redness of the left eye (LE). He was generally unwell since a month, previously. Examination showed relative afferent pupillary defect (RAPD) in the affected eye and visual acuity was hand movement. There was moderate anterior chamber and vitreous reaction. Fundus examination showed a huge dome-shaped choroidal mass covering the entire macula. Diagnosis of severe endogenous endophthalmitis was made, with isolation of Enterobacter sp. from his blood culture. Meanwhile, he also had elevated inflammatory markers with presence of leucocytosis, neutrophilia and elevated erythrocyte sedimentation rate (ESR) as well as C-reactive protein (CRP). Vitreous tap and aqueous tap had no growth, He improved with combination of intravitreal and systemic antibiotic, as shown by the resolved fever and reduced inflammatory markers but progressive inflammation occluded the fundus details and the LE vision eventually became no projection of light despite treatment. Subsequently, he developed rubeotic glaucoma and was treated conservatively because the LE was painless with poor vision. The repeated blood culture and urine was normal. In conclusion, endogenous endophthalmitis with eventual panophthalmitis is difficult to treat and has very poor visual prognosis. Our case highlights the challenges faced in the management of vision-threatening endophthalmitis and panophthalmitis in this patient.
format Article
author Teo, BH
Safinaz Mohd Khialdin,
Umi Kalthum MN,
Wan Haslina WAH,
spellingShingle Teo, BH
Safinaz Mohd Khialdin,
Umi Kalthum MN,
Wan Haslina WAH,
Severe endogenous endophthalmitis with panophthalmitis-lessons to learn
author_facet Teo, BH
Safinaz Mohd Khialdin,
Umi Kalthum MN,
Wan Haslina WAH,
author_sort Teo, BH
title Severe endogenous endophthalmitis with panophthalmitis-lessons to learn
title_short Severe endogenous endophthalmitis with panophthalmitis-lessons to learn
title_full Severe endogenous endophthalmitis with panophthalmitis-lessons to learn
title_fullStr Severe endogenous endophthalmitis with panophthalmitis-lessons to learn
title_full_unstemmed Severe endogenous endophthalmitis with panophthalmitis-lessons to learn
title_sort severe endogenous endophthalmitis with panophthalmitis-lessons to learn
publisher Pusat Perubatan Universiti Kebangsaan Malaysia
publishDate 2019
url http://journalarticle.ukm.my/15232/1/24_ms0270_pdf_12740.pdf
http://journalarticle.ukm.my/15232/
http://www.medicineandhealthukm.com/toc/14/1
_version_ 1678593699563438080
score 13.211869

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