Exogenous endophthalmitis caused by Citrobacter Koseri

Abstract

Aims/Purpose: To present a case of exogenous endophthalmitis caused by Citrobacter Koseri.Methods: We present a 66‐year‐old man that works in an animal laboratory exercising their care, who came to the emergency department due to sudden loss of vision in his left eye. Using indirect ophthalmoscopy, we observed a dense hemovitreous that prevented visualization of the posterior structures. An ocular ultrasound was performed in which suggestive signs of retinal detachment are intuited, so we decided to perform an exploratory vitrectomy. During exploratory vitrectomy via pars plana, a dense fibrinoid vitreous was observed, with a tear at XIIh of more than 1 h in diameter. The vitrectomy was completed successfully after suturing the sclerotomies.Results: The postoperative period evolved adequately, but 3 days later, the patient presented to the emergency room with pain and severe ocular inflammation. On physical examination, he presented intense conjunctival hyperemia, signs of corneal melting, and increased ocular tone. Endophthalmitis was diagnosed and treatment was started with reinforced intravitreal and eye drops antibiotics and anti‐inflammatories. 24 h later, the patient went back with an extrusion of the lens that was sent to microbiological study. On physical examination, we observed corneal melting that produced complete corneal perforation with extrusion of purulent and vitreous material and an urgent evisceration was performed. Two days later, the microbiological samples confirmed the Citrobacter Koseri microorganism.Conclusions: Cases of exogenous endophthalmitis caused by Citrobacter are limited in the literature. In this case, exposed suture material and the epidemiological history of the patient were suspected as the source of infection. Despite early diagnosis and intensive treatment, the clinical course of Citrobacter endophthalmitis is very aggressive and has a poor visual prognosis. In our case it ended with evisceration.