Endogenous Vancomycin-Resistant Enterococcus gallinarum Endophthalmitis in Hematologic Malignancy

Abstract

Patients with hematologic malignancy are immunocompromised either due to the underlying disease or from chemotherapy, resulting in an increased risk for opportunistic infections. Neutropenic patients with vancomycin-resistant Enterococci colonization are at risk of bacteremia with rare endogenous dissemination, which can result in hematogenous spread to the eye. We describe a patient with a hematologic malignancy with treatment-related neutropenia who developed endogenous vancomycin-resistant Enterococcus gallinarum endophthalmitis along with a review of the literature related to this case.

Enterococcus gallinarum endophthalmitis and meningitis in an allogeneic hematopoietic stem cell transplant patient: A case report and literature review

“…After appropriate reports were identified, we reviewed their references and other articles that cited these. We identified two case reports of E. gallinarum endophthalmitis (Table 1) and one case series of enterococcal endophthalmitis, which included four cases with E. gallinarum (no specific details to these cases are provided) (7)(8)(9). The first of the two described cases was of a young man who developed a polymicrobial infection with E. gallinarum and Acinetobacter sp after sustaining a penetrating eye injury and subsequent intraocular foreign body (7).…”

“…Despite initially having a retinal detachment, he improved with therapy and ultimately achieved 20/80 visual acuity after 7 months of follow-up (7). The second described case was a woman with acute myeloid leukemia and prolonged pancytopenia who became bacteremic with E. gallinarum and subsequently seeded her eye; she was successfully treated with oral linezolid, intravitreal vancomycin, ceftazidime, amikacin and voriconazole, and vitrectomy (8). She received a haploidentical HSCT 4 months following this infection without any recurrent ophthalmic disease.…”