SUMMARY A patient with endogenously acquired Clostridium septicum panophthalmitis is presented. The patient exhibited a striking sequence of signs and symptoms associated with this devastating ocular infection. Intensive antibiotic therapy was ineffective and enucleation of the globe was required. The microscopic pathology of the enucleated globe showed extensive infarction and necrosis of ocular structures in association with the panophthalmitis. In addition thrombosis of the central retinal artery and of choroidal vessels was observed. Physical examination revealed a Caucasian male appearing acutely ill with abdominal pain, mild diaphoresis, and chills. Vital signs on admission were blood pressure 150/68 mmHg, pulse 100/minute and regular, respiratory rate 32/minute, and temperature 38-90C. Eye examination by his internist at this time showed the pupils to be equal and reactive to light, and a funduscopic examination showed nothing abnormal. On cardiovascular examination a grade 3/6 systolic murmur was heard. The abdominal examination revealed decreased bowel sounds, with diffuse tenderness, especially in the right upper quadrant. There was no rebound or guarding tenderness. On rectal examination no masses were felt. Occult blood was detected in the stools. The remainder of the physical examination was unremarkable.Laboratory data on admission showed a white cell count of 23.7x 109/l, with 88 polymorphonuclear cells and 10 band forms per 100 cells. The haemoglobin was 13-1 g/dl and the packed cell volume (haematocrit) was 0-37. Other significant values include a blood urea nitrogen level of 24 mg/dl (4-0 mmol/l), creatinine of 1*3 mg/dl (115 itmol/l), and a decreased total protein and albumin of 5.2 g/dl (52 g/l) and 2*9 g/dl (29 g/1), respectively. Radiological examination included chest, anteroposterior plane film of the abdomen, biliary tree scan, and intravenous pyelogram. All these studies were within normal limits. A peritoneal lavage was negative for red blood cells. The differential diagnosis at this time included subacute bacterial endocarditis, pneumonia, or a primary abdominal process such as 380 on 12 May 2018 by guest. Protected by copyright.
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