J Korean Ophthalmol Soc.  2013 Feb;54(2):370-374. 10.3341/jkos.2013.54.2.370.

A Case of Bilateral Endogenous Endophthalmitis in a Streptococcus pneumoniae Meningitis Patient

• Lee MS
• Chang MH

• KMID: 2216677
• DOI: http://doi.org/10.3341/jkos.2013.54.2.370

Abstract

PURPOSE
To report a case of bilateral endogenous endophthalmitis in a Streptococcus pneumoniae meningitis patient.
CASE SUMMARY
A 45-year-old woman with bacterial meningitis was referred to the ophthalmologic clinic with acute visual impairment in both eyes. The patient's visual acuities were hand motion in both eyes. Ophthalmoscopy revealed inflammation in the anterior chamber and vitreous opacities in both eyes. Streptococcus pneumoniae was isolated in the cerebrospinal fluid sample, but not in vitreal, blood samples. Vision improved to 70/100 in the right eye and 2/100 in the left eye after 8 days of treatment.
CONCLUSIONS
Endogenous endophthalmitis constitutes a rare complication of Streptococcus pneumoniae meningitis, and a prompt diagnosis and administration of empirical intravitreal antibiotics can lead to a more favorable visual prognosis.

Keyword

Endogenous endophthalmitis; Meningitis; Streptococcus pneumoniae

MeSH Terms

Anterior Chamber
Anti-Bacterial Agents
Endophthalmitis
Eye
Female
Hand
Humans
Inflammation
Meningitis
Meningitis, Bacterial
Meningitis, Pneumococcal
Ophthalmoscopy
Prognosis
Streptococcus
Streptococcus pneumoniae
Vision Disorders
Vision, Ocular
Visual Acuity
Anti-Bacterial Agents

Figure

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  Figure 1. Slit lamp photographs at presentation. Both eye show marked conjunctival hyperemia, subconjunctival hemorrhage, and mild chemosis.

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  Figure 2. Fundus photographs at presentation. Right eye shows multiple ischemic changes and mild retinal hemorrhage. Left eye shows multiple ischemic changes, moderate retinal hemorrhage, and obstructed vessels.

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  Figure 3. Fluorescein angiography at presentation. Venous phase fluorescein angiogram of both eyes demonstrating occlusive retinal vasculitis, retinal hemorrhages. Note the peripheral retina with extended leakage of inflamed vessels and optic disc.

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  Figure 4. Brain M R Images at presentation. Brain M RI enhance images (transverse section) show diffuse prominent leptomengeal enhancement, most suggested meningitis.

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  Figure 5. Fundus photographs at 6 months after treatment. Right eye shows mild retinal hemorrhage. Left eye shows mild retinal hemorrhage, ghost vessels on peripapillary area and a pale optic disc.

Reference

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