Endophthalmitis Caused by Curtobacterium pusillum Following Open Globe Injury

Abstract

Purpose: To report the first case of <i>Curtobacterium</i> endophthalmitis within 6 hours after open globe injury, with extensive phlebitis and secondary subretinal neovascularization. Case summary: A 53-year-old man with hypersensitivity to beta-lactam antibiotics was admitted due to visual disturbance in the left eye experienced while working in a rural area. Fundus examination was impossible due to a full-layer corneal laceration and traumatic cataract in the left eye. B-scan ultrasonography and orbital computed tomography showed no shadowing of retained intraocular foreign bodies. After a corneal scraping smear, primary closure, lensectomy, and vitrectomy were performed. Organic material was observed in a focal area of pale macula, accompanied by extensive retinal phlebitis in the mid-periphery. After diagnosing acute bacterial endophthalmitis, intravitreal vancomycin and dexamethasone were injected. <i>Curtobacterium pusillum</i> was cultured on an automated microbial identification system. Intravenous vancomycin and oral clarithromycin were administered for 2 weeks. After 3 months, endophthalmitis had not recurred, and the visual acuity reached 20/100. However, subretinal neovascularization was newly detected under the damaged macula. No complications of neovascularization were observed until 6 months after primary closure. Conclusions: <i>Curtobacterium pusillum</i> can induce acute endophthalmitis through direct penetration in cases of ocular trauma, and may be accompanied by extensive phlebitis and secondary subretinal neovascularization. In cases of open globe injury sustained in rural areas, acute endophthalmitis caused by a rare Gram-positive bacillus, such as <i>Curtobacterium</i> species, should be considered.