Platelet Transfusion Related Panophthalmitis and Endophthalmitis in Patients with Dengue Hemorrhagic Fever.

Dengue is a vector-borne viral illness of major public health importance. It is endemic in many parts of India and also causes frequent epidemics. Platelet transfusions are given in severe cases of dengue fever to treat and prevent hemorrhagic complications. Here, we report three patients in North India with development of panophthalmitis and endophthalmitis shortly after receiving platelet transfusion.

Aspergillus spp. panophthalmitis with intralenticular invasion in dogs: report of two cases.

This case series describes the ocular, clinical and histologic manifestations of disseminated Aspergillosis in two dogs. Two dogs presented for severe unilateral panophthalmitis and secondary glaucoma with positive Aspergillus spp. titers. Case 1 showed no clinicopathologic systemic symptoms of fungal dissemination, however, case 2 was affected with acute renal failure. The affected eye of case 1 did not respond to medical therapy and was enucleated for comfort. The affected eye of case 2 responded to aggressive topical and systemic medical therapies, however, the patient was euthanized for acute renal failure. Globes were collected for histologic evaluation at the time of death. Histology of both revealed panophthalmitis with presence of significant intraocular hemorrhage, multifocal fungal granulomas, retinal and optic nerve changes consistent with secondary glaucoma, rupture of the anterior lens capsule, and fungal invasion and colonization of the intralenticular space. These cases represent a unique and devastating ocular manifestation of disseminated Aspergillosis. Cases presenting with uveitis and secondary glaucoma of unknown origin, especially with confirmed or suspected lens capsular rupture, should have serologic testing for this infectious agent.

Orbital Cellulitis with Endogenous Panophthalmitis Caused by Methicillin-Sensitive Staphylococcus aureus in Pregnancy.

Orbital cellulitis along with panophthalmitis is uncommon. The causes are usually trauma-related or endogenous. The prognosis in terms of globe salvage is very poor, with most cases usually requiring enucleation or evisceration of the affected eye. Immunosuppression in some form is usually present, which accounts for the aggressive course of the infection. In this communication, we report on a case in a 25-year-old female, who in the second trimester of pregnancy had developed orbital cellulitis and panophthalmitis caused by methicillin-sensitive Staphylococcus aureus (MSSA), with the primary source of infection being cellulitis on her forearm following intravenous therapy for severe anemia. Despite intensive intravenous and topical antibiotics, she required an evisceration of the eye. However, the pregnancy continued uneventfully with the delivery of a full-term, healthy infant. Bacteremia, although rare in pregnancy, can cause endogenous panophthalmitis and orbital cellulitis, especially in a background of immunosuppresssion.

Clostridium perfringens Keratitis Leading to Blinding Panophthalmitis.

PURPOSE: The purpose of this study was to report a case of Clostridium perfringens keratitis, which led rapidly to panophthalmitis, with loss of the eye in a healthy patient. METHODS: Clinicopathologic case report, with a brief review of the literature. An otherwise healthy 50-year-old man without known risk factors developed a corneal ulcer, and within 48 hours, he lost all vision, with corneal perforation and panophthalmitis. The eye was enucleated, and the globe was examined histopathologically. RESULTS: The cornea was sampled for Gram staining and cultures, which revealed gram-positive rods and the growth of C. perfringens in the anaerobic culture. The globe revealed corneal necrosis and perforation, with acute inflammation in all layers of the eye. Gram-positive bacilli, consistent with C. perfringens, were identified in the vitreous cavity abscess. CONCLUSIONS: C. perfringens endophthalmitis cases from penetrating injuries are fulminant infections, with near universal loss of the eye, whereas C. perfringens keratitis cases are relatively indolent infections. To the best of our knowledge, this is the first report of a C. perfringens keratitis, which led rapidly to panophthalmitis. This aggressive behavior of C. perfringens has not been described previously in human subjects.

Case report of tuberculous panophthalmitis.

BACKGROUND: Although tuberculosis is very common in the Indian sub-continent, tuberculous panophthalmitis has not been reported from this region so far. We report a case of a young girl with tuberculous panophthalmitis. CASE REPORT: A 12-year-old female child presented with painless progressive loss of vision in the right eye of two months' duration. Examination revealed diffuse corneal haze with deep vascularization, iris nodules, and scleral necrosis. Histopathological examination of the enucleated eye revealed necrotizing granulomatous inflammation, multiple epitheloid cell granulomas, and Langhan's giant cells, along with large areas of caseous necrosis. Chest X-ray revealed right hilar lymphadenopathy with right lower zone infiltration and a small pleural effusion. Considering the clinical picture, histopathology and chest findings, a diagnosis of disseminated tuberculosis was made, and standard four-drug anti tubercular treatment was started. At 2 months follow up there was radiological resolution of the lung lesions and pleural effusion. CONCLUSIONS: Clinical features suggestive of tubercular panophthalmitis are absence of pain, presence of nodules on or within the eyeball, and spontaneous perforation. We would like to emphasize that in all susceptible individuals presenting with clinical suspicion of ocular tuberculosis it would be prudent to start early anti-tubercular therapy to prevent progression to panophthalmitis. A complete systemic workup to look for any other possible focus of tubercular involvement must be done.

Panophthalmitis due to rhizopus in an AIDS patient: a clinicopathological study.

Various opportunistic infections in the eye have been reported earlier in AIDS. We report a case of panophthalmitis in an AIDS patient where the eviscerated tissue on histopathologic and microbiologic examination showed the fungus Rhizopus.

Unilateral proptosis and orbital cellulitis in eight African hedgehogs (Atelerix albiventris).

Eight African hedgehogs (Atelerix albiventris) were presented with unilateral proptosis. Six animals presented specifically for an ocular problem, whereas two had concurrent neurologic disease. Enucleation and light microscopic examination of tissues was performed in five animals, and euthanasia followed by complete postmortem examination was performed in three animals. Histopathologic findings in all hedgehogs included orbital cellulitis, panophthalmitis, and corneal ulceration, with perforation in seven of eight eyes. The etiology of the orbital cellulitis was not determined, but it appeared to precede proptosis. Orbits in hedgehogs are shallow and the palpebral fissures are large, which may predispose them to proptosis, similar to brachycephalic dogs. This clinical presentation was seen in 15% (8/54) of African hedgehogs presented to the Western College of Veterinary Medicine over a 2-yr period from January 1995 to December 1996 and warrants further investigation.

Lactococcus garvieae and Streptococcus iniae infections in rainbow trout Oncorhynchus mykiss: similar, but different diseases.

Clinical and macroscopic findings (anorexia, lethargy, loss of orientation and exophthalmia) indicate that Streptococcus iniae and Lactococcus garvieae infections of trout share some common features, but histopathology reveals notable differences between the 2 diseases. Meningitis and panophthalmitis are the main lesions among S. iniae infected trout, whereas L. garvieae infection results in a hyperacute systemic disease. Differences in the LD50s of the 2 pathogens and the sudden onset of signs and death correlate with the histopathological findings, indicating the severity of L. garvieae infection of trout.

[Ocular tuberculosis in systemic lupus erythematosus and immunosuppressive therapy]. / Okuläre Tuberkulose bei systemischem Lupus erythematodes und immunsuppressiver Therapie.

BACKGROUND: A marked reduction in eye disease attributed to tuberculosis has occurred over the past several decades. In recent years, however, tuberculosis has reemerged as a serious public health problem. We report a case of a severe ocular tuberculosis in a patient with systemic lupus erythematosus and immunosuppressive therapy. PATIENT: The 36-years-old woman underwent an immunosuppressive therapy because of a systemic lupus erythematosus detected two years earlier. After holidays on the Philippines Mycobacterium tuberculosis was found in a bronchial lavage. Two months later fundoscopy showed severe subretinal exsudation with overlying serous retinal detachment. Within several months these findings progressed to a panuveitis with spontaneous perforation. Histopathologically a granulomatous panophthalmitis could be found with giant cells. Two months later acid-fast bacilli were detected in orbital lesions. CONCLUSION: In immunosuppressed patients there is still an increased risk for severe ocular tuberculosis. Therefore it is important to think of this almost forgotten disease in those cases.

A murine model of experimental autoimmune lens-induced uveitis using Klebsiella O3 lipopolysaccharide as a potent immunological adjuvant.

Experimental autoimmune uveitis and finally panophthalmitis could be produced in mice by repeated immunization of syngeneic eyeball extract mixed with Klebsiella O3 lipopolysaccharide (KO3 LPS) as a powerful immunological adjuvant. No ocular lesions were produced in mice given eyeball extract emulsified in complete Freund's adjuvant (CFA), KO3 LPS alone or eyeball extract alone. Histopathological changes in the ocular lesions at the early stage after the second or tertiary immunization were characterized by infiltration with inflammatory cells in the ciliary body and iris. The iridocyclitis was followed by extensive infiltration of polymorphonuclear leucocytes (PMN) into the cornea, lens and the surrounding tissues after repeated immunization. Finally, these areas were replaced by granulomatous tissues infiltrated with mononuclear cells. On the other hand, the structure of the retina and sclera was partially preserved. Those mice exhibited production of autoantibodies and development of the delayed-type hypersensitivity (DTH) to syngeneic eyeball extract. Moreover, ocular lesions could be produced in normal recipient mice by transfer of sensitized lymphocytes from hyperimmunized mice. Therefore, it was suggested that the ocular lesions produced by repeated immunization with the mixture of eyeball extract and KO3 LPS were due to the autoimmune mechanism. This might be useful to model immunological phenomena in the pathogenesis of human phacoantigenic uveitis.

Community-acquired pseudomonas pneumonia in a normal host complicated by metastatic panophthalmitis and cutaneous pustules.

Pseudomonas aeruginosa is a frequent pathogen of patients with chronic underlying disease in the hospital environment. This organism is, however, an extremely rare cause of either community-acquired pneumonia in a normal host, metastatic bacterial endophthalmitis or metastatic cutaneous pustules. We report here a case combining these three rare manifestations in a previously well young woman, to highlight the serious disease that may result from this pathogen and the difficulties of treatment.

[Fulminant gas gangrene panophthalmia following perforating scleral injury]. / Foudroyante Gasbrand-Panophthalmie nach perforierender Skleraverletzung.

A 13-year-old boy developed Clostridium perfringens panophthalmitis due to a penetrating scleral injury. The characteristic symptoms were unusually severe periocular pain, lid edema, decreased motility and protrusion of the eye, severe conjunctival chemosis, pus covering the conjunctiva and cornea, green-brown hypopyon, gas bubbles in the anterior chamber, and amaurosis within 60 hours. In view of the patient's ocular status and impaired general condition enucleation was unavoidable. The results of laboratory workups are reported in addition to the clinical and ophthalmologic findings.

Sudden visual loss associated with clostridial bacteraemia.

A patient with endogenously acquired Clostridium septicum panophthalmitis is presented. The patient exhibited a striking sequence of signs and symptoms associated with this devastating ocular infection. Intensive antibiotic therapy was ineffective and enucleation of the globe was required. The microscopic pathology of the enucleated globe showed extensive infarction and necrosis of ocular structures in association with the panophthalmitis. In addition thrombosis of the central retinal artery and of choroidal vessels was observed.