Endogenous pneumococcal endophthalmitis followed by pneumococcal-induced uveitis.

ABSTRACT

BACKGROUND: We describe the case of a fulminant bilateral endophthalmitis occurring in a patient, who had 9 years earlier a splenectomy for an idiopathic thrombocytopenic purpura. HISTORY AND SIGNS A 40-year-old woman, back from a trip to Morocco, presented with high fever, rapid decrease in visual acuity and loss of consciousness. Medical examination revealed a pneumococcal meningitis and bilateral endophthalmitis. THERAPY AND OUTCOME: Endophthalmitis was treated with local and intravitreal antibiotics injections (vancomycin and amikacin). Repeated parabulbar betamethasone injections were performed. Intravenous (iv) methylprednisolone pulses were followed by oral steroid therapy while systemic antibiotics were given (ceftriaxone and vancomycin). In spite of this therapy, fundus examination was impossible because the anterior chamber was filled with fibrin. A cataract developed with severe vitritis and we could observe a progressive narrowing of the anterior chamber. The patient underwent a bilateral vitrectomy and lensectomy. The retina had no lesion. No bacteria were found in the vitreous culture. Evolution was characterized by an increased ocular pressure due to anterior synechiae. Visual acuity remained under 1/10. The severe ocular inflammation could be the result of a mixed mechanism including an infectious followed by a severe immune response against bacterial components. CONCLUSIONS: This case report is rare. To our knowledge, only 3 similar cases have been reported in the literature.