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Published on: March 17, 2014
Choroidal metastatic mucinous abscess caused by Pseudomonas aeruginosa: A case report
Zhao Li1, Wen Gao2, Yan-Ming Tian3
1Ophthalmic Center, General Hospital of Xinjiang Military Region, Urumqi 830011, Xinjiang Uygur Autonomous Region, China.
Background:
Pseudomonas aeruginosa (P. aeruginosa) is considered a common pathogenic bacterium. Choroidal metastatic mucinous abscess caused by P. aeruginosa is rarely reported.
Case Summary:
We describe the diagnostic and treatment processes of a case involving a complex choroidal space-occupying lesion. Our analyses of early clinical manifestations revealed a high possibility of choroidal melanoma, as indicated by the choroidal space-occupying lesion and uveitis. Further magnetic resonance imaging results revealed no positive evidence for the diagnosis of choroidal melanoma. The exact properties of the space-occupying lesion could not be ascertained prior to surgery. However, the lesion was subsequently confirmed as a metastatic abscess by diagnostic vitrectomy. The occupying lesion was found to occupy 75% of the vitreous cavity in the surgery. The entire white viscous tissue was completely removed, and the necrotic retina was cleaned up. After surgery, microbiological culture revealed mucoid P. aeruginosa, which was sensitive to a variety of antibiotics. The bacterial infection grew and disseminated towards the outside of the eye. After the fifth injection, the left eye was successfully retained.
Conclusion:
This is a peculiar case because a huge, local, space-occupying lesion had formed due to the dissemination of low-toxic mucinous P. aeruginosa in the blood from the lungs to the choroid. After surgical removal, the bacteria were able to re-grow; thus, local infection re-spread following surgery. The patient lost vision, but we managed to retain the full structure of the eyeball and eliminated the focus of infection.
Insights
A rare choroidal metastatic abscess caused by Pseudomonas aeruginosa was surgically removed. Despite vision loss, the eyeball structure was preserved and the infection eradicated.
Area of Science:
- Ophthalmology
- Infectious Diseases
- Pathology
Background:
- Pseudomonas aeruginosa (P. aeruginosa) is a common pathogen.
- Choroidal metastatic mucinous abscess caused by P. aeruginosa is rarely reported.
Observation:
- A choroidal space-occupying lesion initially suspected as melanoma was diagnosed via vitrectomy as a metastatic abscess.
- The lesion occupied 75% of the vitreous cavity, requiring complete removal of viscous tissue and necrotic retina.
Findings:
- Microbiological culture confirmed mucoid P. aeruginosa, sensitive to multiple antibiotics.
- Post-surgery, the infection re-spread, indicating bacterial regrowth and dissemination.
- Despite vision loss, the eyeball structure was retained and the infection focus eliminated.
Implications:
- This case highlights the challenges in diagnosing and treating rare P. aeruginosa choroidal abscesses.
- Effective management requires prompt surgical intervention and antibiotic therapy.
- Preservation of eyeball structure is achievable even in severe intraocular infections.
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