An unexpected case of iatrogenic Escherichia coli endogenous pan-endopthalmitis after ERCP-associated biliary sepsis: A case report

Abstract

Introduction: Endogenous endopthalmitis is a diagnostically challenging ophthalmic and medical emergency. It has the ability to manifest at any age and is associated with a number of predisposing factors. The rapid progression of disease poses catastrophic risk for adverse outcomes both localised and systemic. To our knowledge, we describe the first reported iatrogenic case of endogenous Escherichia coli–induced endopthalmitis progressing to pan-endopthalmitis as a consequence of endoscopic retrograde cholangiopancreatography. Diagnosis, Interventions and Outcomes: The patient presented with reduced visual acuity and painless red eye; however, apart from biochemistry results suggesting biliary sepsis, no other clinical features of acute disease were noted. Despite rigorous systemic and intravitreal treatment, the rapid progression of disease led to irreversible damage to the eye. Conclusion: Clinicians must maintain a very high index of suspicion when encountering patients after interventional procedures, as misdiagnosis by trained ophthalmologists for endogenous endopthalmitis remains a common occurrence. Prompt identification and diagnosis ensured our patient avoided evisceration and early ophthalmic biopsies guaranteed the correct systemic intervention was started to address the severe subsequent septicaemia.

Endogenous Endophthalmitis—The Clinical Significance of the Primary Source of Infection

“…In a retrospective study in one of the Danish centers carried out in the years 2000–2016, it was shown that complications after intestinal surgery were the source of EE in 6% of cases [ 14 ]. Both bacterial and fungal infections have been reported [ 48 , 49 ]. Complications in the form of EE development occur both after extensive surgeries, such as resection of the intestine or stomach, and definitely less strenuous endoscopic procedures [ 50 , 51 ].…”