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Endogenous Endopthalmitis in Disseminated Methicillin-Sensitive Staphylococcus aureus (MSSA) Bacteremia
Noor Amalina Saidi1, Qi Zhe Ngoo2, Shawarinin Jusoh3
1Ophthalmology and Visual Science, School of Medicine Sciences, Kelantan, MYS.
Abstract:
Endogenous endophthalmitis (EE) is an ocular infection resulting from hematogenous spread from the remote primary source. Risk factors include endocarditis, bacteria meningitis, immunosuppressive state, and invasive procedures in patients with sepsis. We present a case of a 43-year-old gentleman with poorly controlled diabetes mellitus who was admitted for bilateral nasoseptal cellulitis with a right nasal wall abscess and right vocal cord palsy. At presentation, he just had preseptal cellulitis without any posterior segment involvement. He underwent incision and drainage under the Otorhinolaryngology team. Unfortunately, postoperatively he developed sepsis with a hematogenous spread of infection systemically involving his right eye (endophthalmitis) and his heart valve (infective endocarditis). Blood culture revealed Methicillin Sensitive Staphylococcus Aureus (MSSA) infection. He had six weeks of intravenous cloxacillin and three times intravitreal injections of vancomycin and ceftazidime with complete resolution of signs and symptoms. In the case of a poorly controlled diabetic patient with an extensive regional infection, the presence of ocular symptoms and signs that are suggestive of EE must be taken seriously and warrant a complete eye examination as early detection and treatment of EE is crucial for better prognosis.
Insights
Endogenous endophthalmitis (EE) can arise from distant infections, especially in diabetic patients. Early detection and treatment of EE are vital for preserving vision and improving patient outcomes.
Area of Science:
- Ophthalmology
- Infectious Diseases
- Endocrinology
Background:
- Endogenous endophthalmitis (EE) is a severe intraocular infection often originating from hematogenous spread.
- Risk factors for EE include endocarditis, meningitis, immunosuppression, and sepsis-associated invasive procedures.
- Poorly controlled diabetes mellitus is a significant predisposing factor for severe infections.
Observation:
- A 43-year-old male with uncontrolled diabetes presented with severe nasoseptal cellulitis and abscess.
- Initially, he had preseptal cellulitis, but post-operative sepsis led to hematogenous spread.
- The infection manifested as endophthalmitis in the right eye and infective endocarditis.
Findings:
- Blood cultures identified Methicillin-Sensitive Staphylococcus Aureus (MSSA) as the causative agent.
- The patient received intravenous cloxacillin and intravitreal vancomycin and ceftazidime.
- Complete resolution of ocular and systemic infection was achieved after six weeks of treatment.
Implications:
- This case highlights the critical need for prompt ophthalmological evaluation in diabetic patients with extensive regional infections.
- Early diagnosis and aggressive management of endogenous endophthalmitis are crucial for preventing vision loss.
- Integrated care involving Otorhinolaryngology, Infectious Diseases, and Ophthalmology is essential for managing complex cases.
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