Self-induced Elizabethkingia meningoseptica endophthalmitis: a case report

Paul P Connell,Penelope J Allen,Uma Devi,Mary Jo Waters,Sanj Wickremasinghe

doi:10.1186/1752-1947-5-303

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.

Highlights

Endophthalmitis is a sight-threatening condition defined as any inflammation of the internal ocular spaces
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
Endophthalmitis is a sight-threatening condition defined as any inflammation of the internal ocular spaces [1]

Summary

Introduction

Endophthalmitis is a sight-threatening condition defined as any inflammation of the internal ocular spaces [1]. 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 or following a breach of ocular barriers from a periocular infection [2]. At three days after admission, on suspicion of an inferior retinal detachment, he underwent a 23 g pars plana vitrectomy with repeat intra-vitreal antibiotic therapy. Upon close follow-up, his intra-ocular inflammation improved upon topical steroid and antibiotic therapy. At two weeks after initial surgery he presented again with a rhegmatogenous retinal detachment necessitating pars plana vitrectomy, lensectomy, endolaser and silicone oil (Figure 2).

Discussion

Conclusions