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Metastatic Endogenous Endophthalmitis: A Rare Presentation with Methicillin-resistant Staphylococcus aureus Prostatic
Mrugank M Bhavsar1, T V Devarajan1, P Senthur Nembi2
1Department of Critical Care Medicine, Apollo First Med Hospital, Chennai, Tamil Nadu, India.
Summary
A severe eye infection, endogenous endophthalmitis, caused by methicillin-resistant Staphylococcus aureus (MRSA) was successfully treated. The source of the MRSA infection was identified as prostatic abscesses.
Area of Science:
- Ophthalmology
- Infectious Diseases
- Urology
Background:
- Endogenous endophthalmitis is a severe intraocular infection.
- Uncontrolled diabetes and hypertension are risk factors for infections.
Observation:
- A 62-year-old male presented with fever, dysuria, urinary retention, and rapid vision loss.
- Eye examination revealed hypopyon, indicative of endophthalmitis.
Findings:
- Blood, urine, and vitreous cultures identified methicillin-resistant Staphylococcus aureus (MRSA).
- Transrectal ultrasound revealed multiple prostatic abscesses as the source.
- Treatment included empirical and targeted antibiotics (vancomycin, piperacillin-tazobactam, ceftazidime, daptomycin) and intravitreal injections.
- Transesophageal echocardiography excluded infective endocarditis.
Implications:
- Prompt diagnosis and source identification are crucial for managing endogenous endophthalmitis.
- Prostatic abscesses can be a hidden source of MRSA bacteremia and endophthalmitis.
- Multidrug therapy and source control are essential for visual recovery.