Bilateral endogenous endophthalmitis associated with infective endocarditis: case report

Abstract

Bilateral endogenous endophthalmitis is a rare condition initiated by infection by microbes in the bloodstream, such as those arising from a foci of infective endocarditis. We report a case and discuss the diagnostic aspects and the clinical outcome of a patient with characteristic findings of the disease. The patient was a 49 year old white male who had a metallic aortic valve implanted 7 months previously, and who presented to the hospital with 10 days of fever, cough and dyspnea, then diarrhea and mental confusion. On the second day of hospitalization, he experienced sudden loss of vision in both eyes. A Gram-positive coccobacillus was isolated from the bloodstream, he was treated with fluoroquinolone with disappearance of fever, decreased ocular inflammation, and improvement in his vision to light perception. He later underwent valve replacement surgery but died during the procedure. We review the occurrence of ocular signs and symptoms and their importance in patients with endocarditis.

Window to the circulatory system: Ocular manifestations of cardiovascular diseases

“…49 The embolic occlusion of small arteries may produce cotton-wool spots. 50 If larger vessels are involved, it may lead to CRAO, branch retinal artery occlusion (BRAO), or even ophthalmic artery occlusion. 47 CRAO will present as sudden, painless, and complete loss of vision while BRAO may be clinically silent or may present as loss of vision.…”

Metastatic endophthalmitis - Has the trend of causative organism changed in the modern antibiotic era - A Systematic Review

“…In 2001, Arcieri et al reported a patient who developed bilateral EE following group B Streptococcus septicemia along with infective endocarditis. The patient was treated with intravenous fluoroquinolones, but could only recover perception of light in one eye, while the other eye could not perceive light [ 3 ].…”

“…Though, in today’s scenario, with the advent of modern antibiotic regimens, the occurrence of once common causes of septicemia like Salmonella, Staphylococcus aureus, Escherichia coli, etc. is decreasing; other organisms like coagulase negative Staphylococci, Candida species and non-fermenting gram negative bacilli are causing more and more blood stream infections in immunocompromised, chronically ill and hospitalized patients [ 3 - 5 ].…”

Ocular Manifestations of Endocarditis

“…Systemic therapy may be sufficient when the vitreous cavity is not greatly involved. In the other cases, antibiotic intravitreal injections and vitrectomy are necessary [5,[8][9][10][11].…”