Delayed onset Cutibacterium (formerly Propionibecterium) acnes endophthalmitis triggered by intravitreal steroid injection.

Abstract

We report a case of delayed onset Cutibacterium acnes (C. acnes, formerly Propionibacterium acnes or P. acnes) endophthalmitis with onset triggered by intravitreal steroid (triamcinolone acetonide; TA) injection in a pseudophakic patient, 7 years after cataract surgery.Methods/Patients: A 67 years old, male presented with gradual worsening of vision, eye redness and photosensitivity that started a month after intravitreal TA injection (Triescience, 4mg/0.1mL, Alcon Labs, Fort Worth, TX) for cystoid macular edema secondary to branch retinal vein occlusion in the right eye. Patient had undergone cataract surgery with intraocular lens (IOL) in that eye 7 years prior. Exam showed visual acuity of counting fingers at 3 feet, conjunctival injection, with 2+ anterior chamber cell and 2+ vitreous haze. Uveitis work up including Angiotensin converting enzyme (ACE), Quantiferon Gold, and syphilis IgG screen was negative. Diagnostic pars plana vitrectomy (PPV) with intravitreal injection of antibiotics was performed and vitreous sample was sent for detailed laboratory analysis. Vitreous fluid analysis was positive for C. acnes and negative for viral, fungal and malignant cells. Although the patient received intravitreal antibiotics injection twice, the intraocular infection and inflammation persisted which eventually required an IOL and capsular bag removal, followed by insertion of a secondary IOL later. Delayed onset C. acnes endophthalmitis may be triggered by an intravitreal steroid injection in pseudophakic patients.