Endogenous endophthalmitis is a vision-threatening condition that results from the hematogenous spread of infection to the eye that originated in a distant primary focus. Although it has long been recognized that bloodborne organisms can infect the eye, endogenous bacterial endophthalmitis is considered a rare entity. We present a unique case of a critically ill patient with a cholangiocarcinoma complicated by ascending cholangitis who developed endogenous Pseudomonas aeruginosa endophthalmitis. An awareness of the risk factors predisposing to endogenous endophthalmitis and a high clinical suspicion are necessary to make an early diagnosis in the intensive care unit. Management involves an aggressive combined medical and surgical approach in an effort to prevent ocular morbidity and vision loss.
This case report and a review of the available literature suggest that thrombosis associated with femoral vein catheterization should be considered when clinicians decide where to obtain central venous access when multiple sites are available. This report also suggests the utility of serial ultrasound examinations to define clinically nonapparent thrombosis as an early indicator of a potentially catastrophic complication.
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