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Published on: February 6, 2021
Orbital cellulitis and endophthalmitis in pseudomonas septicemia
Panitee Luemsamran1, Kanograt Pornpanich, Sumalee Vangveeravong
1Department of Ophthalmology, Mahidol University, Siriraj Hospital, Bangkok, Thailand.
Orbit (Amsterdam, Netherlands)
|December 17, 2008
Summary
This case highlights a rare instance of Pseudomonas aeruginosa bacteremia causing simultaneous orbital cellulitis and endophthalmitis. Prompt antibiotic treatment and surgical intervention were crucial for managing this severe ocular infection.
Area of Science:
- Ophthalmology
- Infectious Diseases
- Bacteriology
Background:
- Community-acquired Pseudomonas aeruginosa bacteremia can lead to severe systemic and localized infections.
- Orbital cellulitis and endophthalmitis are serious conditions that can result in vision loss.
- Endogenous spread of bacteria presents a diagnostic and therapeutic challenge.
Observation:
- A seemingly healthy individual developed Pseudomonas aeruginosa bacteremia with concurrent pneumonia and ecthyma gangrenosum.
- The patient presented with rapidly progressing orbital cellulitis and endophthalmitis originating from a lower eyelid abscess.
- Degradation of scleral and corneal tissue by Pseudomonas aeruginosa exocellular products led to a near-perforated cornea.
Findings:
- Treatment involved intravenous, intravitreal, and topical antibiotics, alongside surgical management including a tarsoconjunctival flap.
- Despite aggressive therapy, the patient's final visual acuity was limited to light perception.
- Drug-induced neutropenia was identified as a significant risk factor in this case.
Implications:
- This case underscores the aggressive nature of Pseudomonas aeruginosa endogenous infections affecting the eye.
- Early recognition and multidisciplinary management are critical for optimizing outcomes in similar complex cases.
- The study emphasizes the importance of considering endogenous bacteremia in patients with severe ocular and systemic infections.
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