PAENIBACILLUS LAUTUS : A NEW FOE IN ENDOGENOUS ENDOPHTHALMITIS

Area of Science:

• Ophthalmology
• Microbiology
• Genetics

Background:

• Endogenous endophthalmitis (EE) is a severe intraocular infection.
• Rare pathogens can present diagnostic challenges, mimicking other ocular conditions like granulomatous uveitis.
• Pediatric cases of EE require prompt and accurate diagnosis for effective management.

Purpose of the Study:

• To report a rare case of endogenous endophthalmitis caused by Paenibacillus lautus in a child.
• To highlight the diagnostic utility of 16S rRNA gene sequencing for identifying difficult-to-culture pathogens.
• To discuss the clinical management of this complex case.

Main Methods:

• Retrospective chart review of a pediatric patient with suspected endogenous endophthalmitis.
• Comprehensive microbiologic workup including microscopy, culture, and PCR-based 16S rRNA gene sequencing.
• Surgical management including anterior chamber tap, vitrectomy, lensectomy, and subsequent retinal detachment repair.

Main Results:

• A 13-year-old boy presented with uveitis, hypopyon, and cataract, initially mimicking granulomatous uveitis.
• Conventional cultures failed to identify the causative agent, a Gram-variable bacillus.
• 16S rRNA gene sequencing successfully identified the pathogen as Paenibacillus lautus.
• The patient required multiple surgical interventions, including management of rhegmatogenous retinal detachment.

Conclusions:

• Paenibacillus lautus is a rare cause of endogenous endophthalmitis that can mimic granulomatous uveitis.
• 16S rRNA gene sequencing is a valuable tool for etiological diagnosis when conventional microbiological methods are insufficient.
• Accurate and timely diagnosis is crucial for appropriate management of pediatric endogenous endophthalmitis.