Endogenous endophthalmitis misdiagnosed as non-infectious uveitis among patients with a history of injection drug use

Abstract

Objective Uveitis is an inflammatory process of the eye that can lead to severe vision loss. Non-infectious forms of uveitis constitute the majority of cases and chronic disease is typically treated with immunosuppressive drugs. A minority of uveitis cases are of an infectious cause, and in these cases, the use of immunosuppressive agents may aggravate the underlying infection. Design: Retrospective case series. Result. Five patients who initially presented with ocular findings suspicious for non-infectious uveitis and who were treated with corticosteroids. After failing to respond to corticosteroid therapy, and with a history of injection drug use (IDU) eventually reported by all five patients, there was a high degree of clinical suspicion for an underlying infectious process. All five were later classified as having endogenous endophthalmitis related to IDU, and experienced clinical improvement after antibiotic therapy and pars plana vitrectomy. Conclusions and Importance. Given the ongoing opioid crisis, this study demonstrates the importance of considering IDU-associated endogenous endophthalmitis in any individual with intraocular inflammation and history of IDU presenting with new-onset vision loss, irrespective of time since last reported use.