Posters

Head to toe examination!

Poster Details

First Author: G.Moussa UK

Co Author(s):    J. Virdee   P. Stavrou                 

Abstract Details

Purpose:

A 96 year old Caucasian lady was admitted with a two day history of blurred vision in the right eye (RE) with an ophthalmic history of bilateral pseudophakia and POAG. Visual acuity RE: 6/18, LE: 6/9. Examination of the RE showed ciliary injection, blood stained hypopyon, corneal oedema and dense vitritis. Patient underwent vitreous biopsy and intraocular antibiotic injection of vancomycin and ceftazidine. She was initiated on systemic ciprofloxacin and intensive topical antibiotics. Initial investigations were blood tests and cultures, urinary sampling, and chest radiograph. Swabs from her hallux were taken due to evidence of recent trauma.

Setting:

This patient was seen at a tertiary referral Centre at the Birmingham Midland Eye Centre.

Methods:

Retrospective observational case report of a novel cause of endogenous endophthalmitis. A literature review was undertaken to compare similar cases for evidence based medicine.

Results:

Vitreous culture grew rhizobium radiobacter, a gram negative bacilli. That is a soil plant pathogen and this is the first reported case of endogenous endophthalmitis caused by it. Sensitivities to ciprofloxacin, ceftazidine and gentamicin were demonstrated and a second injection of intravitreal antibiotics was given due to persistent dense vitreous activity. A thorough systemic examination and the chest radiograph showed right lower lobe pneumonia. The RE, on follow up, showed clearing of the cornea and resolution of the hypopyon. However visual acuity remained poor at perception of light due to persistent vitreous activity. The patient died one month after diagnosis, due to other medical co-morbidities, so long term progress was unattainable.

Conclusions:

This rare case demonstrates a novel causative pathogen of endogenous endophthalmitis. The authors speculate haematogenous spread of this microbe following trauma to the right hallux in the garden a week prior to symptoms, leading to pneumonia and endogenous endophthalmitis. All patients should have a septic screen and thorough systemic examination on admission to avoid delay to possible life-saving treatment. Poorly mounted immune response may diminish cardinal signs and symptoms for sepsis. All investigations should be followed up promptly with multidisciplinary effort. With unusual pathogens, a literature review may aid with the management of patient.

Financial Disclosure:

NONE