Aggregatibacter Endophthalmitis in a patient with Dentophobia.

Abstract

To describe a rare case of unilateral, endogenous endophthalmitis caused by Aggregatibacter aphrophilus (HACEK group) confirmed in vitreous and blood cultures, in a patient with dentophobia. Case report. 75-year-old male patient with type 2 diabetes, previous myocardial infarction, and pacemaker implantation. Patient was seen with sudden loss of vision at the Dept of Ophthalmology, Uppsala University. Initial diagnosis was posterior vitreous detachment and anterior uveitis, but progression of disease led to vitrectomy, which actually demonstrated endophthalmitis and growth of Aggregatibacter aphrophilus of the HACEK group. Aggregatibacter bacteremia and pacemaker endocarditis were also identified and dental examination confirmed growth of Aggregatibacter in the oral cavity. Intravitreal treatment with ceftazidime and vancomycin according to EVS (Endophthalmitis Vitrectomy Study) protocol was administered with quick resolution of endophthalmitis. Aggregatibacter endophthalmitis is a rare but devastating cause of vision loss where immediate diagnosis may be delayed. Prompt diagnosis may be facilitated by a thorough medical history and early vitreous biopsy. Systemic investigation by an infectious disease specialist and multidisciplinary assessment are mandatory. Ophthalmological treatment is effective with intravitreal injections of ceftazidime and vancomycin.