Acute painful vision loss and acute abdomen: a case of endogenous Clostridium perfringens endophthalmitis

“…In contrast to this, endogenous C perfringens endophthalmitis tends to have a poor outcome. Lauer et al 3 describes a case that resulted from a peritoneal infection, as well as reviewing two other previously reported cases due to cholecystitis. Two of these cases died from systemic complications, and the third case suffered a spontaneous globe perforation and was eviscerated.…”

Section: Discussionmentioning

confidence: 99%

“…It is an uncommon causative organism of endophthalmitis, and has been typically reported following trauma,1 and less frequently following intraocular procedures2 and endogenously 3. Despite aggressive treatment it has a devastating outcome, with most eyes requiring evisceration or enucleation.…”

Section: Introductionmentioning

confidence: 99%

Clostridium perfringens endophthalmitis following perforating eye injury

Lee

Idrees²,

Kinsella³

2009

Case Reports

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A 59-year-old man presented with endophthalmitis, following a perforating eye injury from pulling out a wire that was embedded in the ground. On presentation, his vision was perception of light (PL). Tetanus toxoid was given, and he was commenced on ciprofloxacin. A primary repair was performed. Conjunctival swabs, discharge from wound site and anterior chamber aspirate were sent for culture. The eye was tense and the anterior chamber was full of a gelatinous brown substance which precluded performance of vitrectomy. Intravitreal vancomycin and ceftazidime was given. Hourly topical fortified vancomycin and ceftazidime was given. Postoperatively, the patient's vision remained PL with no evidence of improvement. On day 2, Clostridium perfringens was cultured. The patient was commenced on intravenous benzylpenicillin and clindamycin. Intravitreal clindamycin and vancomycin was administered. The patient was NPL on day 3. There was no evidence of response to treatment and an evisceration was performed on day 6.

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“…The source Clostridium perfringens is usually exogenous [1–6], and there is limited literature regarding an endogenous source. Endogenous Clostridium perfringens endophthalmitis can pose serious threats to both vision and is associated with high mortality [7, 8]. Previous reports demonstrated an underlying inflamed gallbladder [9], biliary infection [7], and acute abdomen [8] as causative sources.…”

Section: Introductionmentioning

confidence: 99%

EndogenousClostridium perfringensPanophthalmitis with Potential Entry Port from Diverticulitis Exacerbated by Proliferative Diabetic Retinopathy

Neerukonda

Cheng

Dhanireddy

et al. 2019

Case Reports in Ophthalmological Medicine

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Purpose. To report a rapid endogenous fulminating panophthalmitis from Clostridium perfringens in a patient with diverticulitis and proliferative diabetic retinopathy. Methods. A 61-year-old female with poorly controlled diabetes mellitus, active proliferative diabetic retinopathy, and recent diverticulitis presented with conjunctival injection, ocular discharge, and sudden onset of painful vision loss of the left eye. Patient denied history of ocular trauma, intraocular surgery, or intravenous drug abuse. Examination revealed an erythematous, proptotic eye with restricted extraocular movements, mucopurulent discharge, diffuse corneal edema, and vitreous haze and cell. Orbital computed tomography (CT) confirmed no retained intraocular foreign body. Results. Despite 48 hours of treatment with systemic broad spectrum antimicrobial therapy (vancomycin, meropenem, and amphotericin B), patient underwent enucleation due to declined condition and progressive infection. Patient’s culture revealed gram-positive bacillus microbes (Clostridium perfringens). Patient’s subsequent CT abdomen showed resolved diverticulitis after antimicrobial therapy. Conclusion. Although rare, Clostridium perfringens infection can be a cause of rapid loss of vision from fulminate endogenous panophthalmitis. Urgent extensive systemic work-up to identify potential port of entry from visceral pathology and rapid removal of source of infection are pivotal to avoid high rate of mortality.

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Acute painful vision loss and acute abdomen: a case of endogenous Clostridium perfringens endophthalmitis

Cited by 9 publications

References 8 publications

Clostridium septicum endophalmitis associated with colon adenocarcinoma

Clostridium septicum endophalmitis associated with colon adenocarcinoma

Clostridium perfringens endophthalmitis following perforating eye injury

EndogenousClostridium perfringensPanophthalmitis with Potential Entry Port from Diverticulitis Exacerbated by Proliferative Diabetic Retinopathy

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