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Bilateral hematogenous Pseudomonas aeruginosa endophthalmitis after lung transplantation
S Dua1, W Chalermskulrat, M B Miller
1Division of Pulmonary Diseases, Critical Care Medicine and Lung Transplantation, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA.
Abstract:
Pseudomonas aeruginosa commonly colonizes the airways of patients with cystic fibrosis (CF). However, the occurrence of bacteremia with metastatic infection to the eye causing endogenous endophthalmitis is very rare. In the setting of lung transplantation, the significance of P. aeruginosa bacteremia in patients with CF whose airways are colonized before transplantation is unknown. We report a case of bilateral P. aeruginosa endogenous endophthalmitis in a patient with CF after lung transplant without documented bacteremia. The patient presented with acute eye symptoms in the presence of a left atrial thrombus and the disease followed a rapidly progressive course requiring aggressive medical-surgical treatment. Typically P. aeruginosa endophthalmitis has been associated with a poor visual prognosis. However, with combined medical-surgical management this patient retained useful vision in one eye without having retinal detachment or requiring enucleation. Endogenous endophthalmitis should be considered in the differential diagnosis of ocular complaints in patients with CF after lung transplant.
Insights
Pseudomonas aeruginosa can cause rare eye infections like endophthalmitis in cystic fibrosis (CF) patients post-lung transplant. This case highlights successful vision preservation with prompt medical and surgical intervention.
Area of Science:
- Ophthalmology
- Infectious Diseases
- Pulmonology
Background:
- Pseudomonas aeruginosa colonization is common in cystic fibrosis (CF) patients' airways.
- Endogenous endophthalmitis from P. aeruginosa bacteremia is rare, especially post-lung transplant in CF patients.
- The role of P. aeruginosa bacteremia in CF patients with pre-transplant airway colonization is unclear.
Observation:
- A case of bilateral P. aeruginosa endogenous endophthalmitis occurred in a CF patient after lung transplantation.
- The patient presented with acute ocular symptoms and a left atrial thrombus.
- The condition progressed rapidly, necessitating intensive medical and surgical management.
Findings:
- Despite the absence of documented bacteremia, P. aeruginosa caused bilateral endogenous endophthalmitis.
- Aggressive combined medical-surgical treatment led to the retention of useful vision in one eye.
- The patient avoided retinal detachment and enucleation.
Implications:
- Endogenous endophthalmitis should be considered in the differential diagnosis of ocular symptoms in post-lung transplant CF patients.
- Prompt and aggressive multimodal treatment can potentially improve visual outcomes in this rare condition.
- This case expands understanding of P. aeruginosa ocular complications in immunocompromised CF patients.
