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PURPOSE: To report a case of endogenous endophthalmitis caused by Sphingomonas paucimobilis in a young male. MATERIALS AND METHODS: A retrospective case report. RESULTS: A 25-year-old male presented with reduced vision in the right eye and recurrent past episodes of hypopyon uveitis. The right eye had vision of counting fingers close to the face with cells, flare, and hypopyon in the anterior chamber with vitritis and exudates in the fundus. Blood investigations for tuberculosis, syphilis, toxoplasma, sarcoidosis, RA, ANA, HLA B27, and HLA B29 were negative. Anterior chamber tap investigations for herpes simplex viruses, varicella-zoster virus, cytomegalovirus, and toxoplasma, as well as Mycobacterium tuberculosis, yielded negative results. Ultrasound B-scan revealed a moderate number of low-reflective dot echoes in the vitreous, along with a few membranous echoes suggestive of vitritis. Blood culture and urine culture were negative. Since there was progressive deterioration, diagnostic and therapeutic vitrectomy was done with intravitreal antibiotics. The culture of the vitreous sample grew Sphingomonas paucimobilis. In the post-operative period, the patient developed retinal detachment, and re-surgery was done with a lensectomy, and the vision improved to 6/18 with contact lenses in the follow-up. CONCLUSION: This case report describes the distinct occurrence of endogenous endophthalmitis in an immunocompetent young male, which was previously reported only in peripartum cases. The clinical course is characterized by masquerading symptoms and recurrent episodes, despite the organism being of low virulence.
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PURPOSE: To study the clinical features, causative factors and treatment outcomes in patients with infectious scleritis seen in India. METHODS: A retrospective study of all patients examined at a tertiary care center between August 2012 and March 2021. RESULTS: Forty-five patients (45 eyes; mean age 52.7 ± 17.5 years) were included in the study. The mean duration of symptoms was 3.1 ± 4.4 months. Inciting factors were found in 53.3% (injury: 33.3%; ocular surgery: 20.0%). The scleritis was predominantly anterior (97.8%), with multiple lesions in 40.0%, a solitary lesion in 31.1%, and diffuse in 28.9%. Associated features included uveitis (51.1%), keratitis (37.8%), hypopyon (15.6%), and endophthalmitis (6.7%). Causative organisms included bacteria (53.3%), fungi (35.6%), and presumed herpes virus (11.1%). All patients were treated with antimicrobial agents along with systemic corticosteroids where indicated. Surgical treatment included scleral debridement (37.8%), patch grafts (4.4%), and penetrating keratoplasty (2.2%). Complete resolution of scleritis was seen in 86.7%, with a mean duration of therapy of 2.9 ± 2.5 months. The mean follow-up was 8.3 ± 14.3 months. 51.1% of patients lost functional vision (<6/60). Causes of decreased vision included corneal scar, cataract, macular scar, glaucomatous optic atrophy, and phthisis bulbi. On bivariate analysis, poor visual acuity at presentation was associated with a worse visual outcome (p = 0.02). Other risk factors included necrotizing scleritis, multifocal scleritis, the presence of keratitis and uveitis. CONCLUSION: In our study, infectious scleritis resulted from bacterial and fungal infections. The scleritis resolved in most subjects, however, vision loss was frequent due to infection-related complications.
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PURPOSE: To discuss the diagnosis and management of a rare case of endogenous endophthalmitis (EE) caused by Paenibacillus lautus mimicking granulomatous uveitis in a child, highlighting the use of 16S rRNA gene amplicon sequencing as an accurate method to identify rare pathogens. METHOD: A retrospective chart review of the clinical presentation, microbiologic workup-including microscopy, culture, antibiotic susceptibility, and polymerase chain reaction for pathogen DNA of clinical samples-and the clinical management of the case were recorded. RESULT: A 13-year-old boy presented with decreased vision in the right eye for one month. On examination, he had uveitis with hypopyon and complicated cataract. The case underwent an anterior chamber tap followed by vitrectomy and lensectomy. The culture of the vitreous aspirate grew Gram-variable bacilli that could not be identified by conventional microbiological techniques. However, PCR-based sequencing of the 16S rRNA gene was performed, and the bacterium was identified as P. lautus. The patient subsequently developed rhegmatogenous retinal detachment, for which he underwent endo laser photocoagulation and oil tamponade. Four months later, silicone oil was removed, and an intraocular lens was implanted. At six weeks follow-up, the retina remained well attached, and intraocular pressure was maintained. CONCLUSION: P. lautus can cause EE and mimic granulomatous uveitis. Techniques such as 16S rRNA gene sequencing can significantly facilitate aetiological diagnosis in cases where conventional methods fail.