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Published on: February 6, 2021
[Bilateral endogenous endophthalmitis]
R Augsten1, E Königsdörffer, A Oehme
1Klinik für Augenheilkunde der Friedrich-Schiller-Universität Jena.
Background:
The endogenous endophthalmitis is a septic-metastatic late complication of a generalized bacterial or fungal infection or an asymptomatic fungaemia. Aspergillus organisms are a rare cause of endophthalmitis. Aspergillus ocular manifestations have been mostly reported in connection with immunosuppression, severe diseases or drug abuse.
Patient And Methods:
A 51-year-old man underwent a kidney transplantation, an immunosuppressive therapy, and, in addition, treatments for some other generalized diseases. Endogenous endophthalmitis was diagnosed in both eyes at an interval of about eight weeks. The treatment included pars-plana-vitrectomy on both eyes.
Results:
At first, an endogenous endophthalmitis was found in the right eye which was assumed to be induced by bacteria. About eight weeks later, however, an endogenous endophthalmitis was diagnosed in the left eye, also, which was caused by Aspergillus. The patient received an intensive medical care including operative, antibacterial and antimycotic treatments. The bacterial endophthalmitis in the right eye was healed, and the state of the left eye was found to be post-operatively stabilized. Unfortunately, the patient died of a septic shock in systemic Aspergillus infection.
Conclusion:
Endogenous endophthalmitis has a very poor prognosis. To our knowledge, the described medical history seems to be the first reported case of an endophthalmitis on both sides, apparently caused by bacteria in one eye and by fungi in the other one.
Insights
This case report details a rare instance of endogenous endophthalmitis in both eyes, initially suspected bacterial and later confirmed fungal (Aspergillus). Despite treatment, the patient succumbed to systemic Aspergillus infection, highlighting the poor prognosis of this condition.
Area of Science:
- Ophthalmology
- Infectious Diseases
- Transplantation Medicine
Background:
- Endogenous endophthalmitis is a severe intraocular infection, often a complication of systemic infections.
- Aspergillus-induced endophthalmitis is rare, typically associated with immunosuppression or severe illness.
- This case involves a kidney transplant recipient on immunosuppressive therapy.
Observation:
- A 51-year-old man presented with sequential endogenous endophthalmitis in both eyes.
- The right eye infection was initially presumed bacterial.
- The left eye infection, occurring eight weeks later, was diagnosed as Aspergillus endophthalmitis.
Findings:
- The patient underwent bilateral pars-plana-vitrectomy and received antibacterial and antimycotic treatments.
- Bacterial endophthalmitis in the right eye resolved; the left eye stabilized post-operatively.
- The patient ultimately died from septic shock due to systemic Aspergillus infection.
Implications:
- This case represents a unique presentation of bilateral endogenous endophthalmitis caused by distinct pathogens (bacteria and Aspergillus).
- It underscores the critical, albeit poor, prognosis of endogenous endophthalmitis, especially in immunocompromised patients.
- Early diagnosis and aggressive multimodal treatment are crucial for managing endogenous endophthalmitis.
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