Self-induced Elizabethkingia meningoseptica endophthalmitis: a case report

Abstract

IntroductionEndophthalmitis is a sight-threatening condition defined as any inflammation of the internal ocular spaces. It is classified as either endogenous or exogenous depending on the route of infection. Exogenous endophthalmitis results from direct inoculation as a complication of intra-ocular surgery, penetrating ocular trauma, intra-ocular foreign bodies, corneal ulceration and following a breach of ocular barriers from a periocular infection. We report a rare case of exogenous endophthalmitis with both unusual etiology and microbiology.Case presentationA 41-year-old Caucasian man with a history of depressive illness presented to our eye department with painful acute visual loss on a background history of chronic uveitis. Ocular examination revealed a dense fibrinous panuveitis with a suspicion of a focal lesion in the posterior segment. Microbiological sampling from his anterior chamber and posterior segment revealed a culture of Elizabethkingia meningoseptica. On closer questioning, he volunteered the occurrence of multiple episodes of deliberate needle ocular penetration. Following vitrectomy for associated retinal detachment, a final Snellen visual acuity of 6/60 was obtained.ConclusionsElizabethkingia meningoseptica endophthalmitis is a rare condition, and visual results to date are poor.

Draft Genome Sequence of Elizabethkingia meningoseptica, Isolated from a Postoperative Endophthalmitis Patient

“…Elizabethkingia meningoseptica , a Gram-negative ubiquitous bacillus, has been reported to be widely distributed in natural environments ( 1 , 2 ). It has also been reported to be associated with infections in humans leading to cerebrospinal meningitis in immunocompromised patients and neonates ( 3 , 4 ), endophthalmitis ( 5 ), and keratitis ( 6 ). Recently, draft genome sequences of E. meningoseptica 502 ( 7 ), NBRC 12535 T , and ATCC 13253 T ( 8 ) have been reported.…”

Bilateral Acute Endophthalmitis Associated With Munchausen Syndrome

“…In the case described by Connell et al, self-infliction was suspected because of the unusual bacterial species involved and confirmed after subsequent patient questioning. 12 In the case of bilateral periocular metallic mercury injections, self-infliction was suspected after CT imaging and eventually confirmed by the patient. In another case, self-infliction was revealed only when prison guards witnessed the patient injecting drugs into his periocular tissues.…”

“…8 However, self-inflicted intraocular injections are very rare. A literature search of all articles in English revealed 5 previously documented cases of intraocular injection, 9-12 3 of which led to endophthalmitis, [11][12][13] and only 1 of which was bilateral (Table 1). 13 In our patient, self-inflicted endophthalmitis occurred from S. epidermidis in the right eye and S. viridans in the left eye.…”

“…Connell et al reported a patient who admitted to over 20 intraocular penetrations with an unsterilized sewing needle over 9 months that eventually led to endophthalmitis. 12 Self-inflicted injury may be difficult to diagnose on initial presentation. In the case described by Connell et al, self-infliction was suspected because of the unusual bacterial species involved and confirmed after subsequent patient questioning.…”

Posttraumatic Keratitis Caused by Elizabethkingia meningosepticum

“…11,12 Another case had keratitis that developed following trichiasis and exposure keratopathy. 13 Bloom et al 14 reported a case with keratitis caused by C. meningosepticum without ocular comorbidities.…”