Korean J Ophthalmol.  2009 Dec;23(4):321-324. 10.3341/kjo.2009.23.4.321.

Bilateral Endophthalmitis as the Initial Presentation of Bacterial Meningitis

Affiliations
  • 1Department of Ophthalmology, Gyeongsang National University, Colleage of Medicine, Jinju, Korea. inyoung@gnu.ac.kr
  • 2Gyeongsang Institute of Health Science, Gyeongsang National University, Jinju, Korea.

Abstract

To report a case of bilateral endophthalmitis as the initial presentation of bacterial meningitis in a young, immunocompetent Korean patient. A 35-year-old female with a one day history of bilateral swollen eyes, visual disturbance, headache, petechial skin rash, and nausea visited our clinic. She was diagnosed as having endogenous endophthalmitis associated with bacterial meningitis. Intravenous broad spectrum antibiotic therapy was initiated with cefotaxime 3 g and ubacillin 3 g, four times daily. Intravitreal antibiotic (vancomycin 1 mg/0.1 mL and ceftazidime 2 mg/0.1 mL) injections were performed in both eyes. Two weeks post presentation, the best corrected visual acuity in both eyes improved to 0.7, and inflammation of the anterior chamber and vitreous cavity was decreased. We recommend that when endogenous endophthalmitis is suspected along with meningitis, or if it is known to be present, intravitreal and intravenous antibiotics should be promptly administered to preserve vision.

Keyword

Endogenous endophthalmitis; Meningitis

MeSH Terms

Adult
Anti-Bacterial Agents/therapeutic use
Diagnosis, Differential
Endophthalmitis/diagnosis/drug therapy/*etiology
Eye Infections, Bacterial/diagnosis/drug therapy/*etiology
Female
Follow-Up Studies
Humans
Meningitis, Bacterial/*complications/diagnosis/drug therapy
Ophthalmoscopy

Figure

  • Fig. 1 At the time of admission. (A) External examination demonstrated markedly injected conjunctiva with severe chemosis and yellowish discharge in both eyes. (B, C) Slit lamp photography revealed marked conjunctival hyperemia, corneal haziness, and mild hypopyon with exudative membranes in the anterior chambers of both eyes. (D) Orbital computed tomography revealed a streaky infiltration in the retrobulbar fat and slightly thickened enhancement in the conjunctiva and preseptal spaces of both eyes.

  • Fig. 2 Fourteen days after admission. (A) This photograph demonstrates markedly improved conjunctival injection with nearly resolved chemosis in both eyes. (B, C) Slit lamp examination also demonstrated diminished conjunctival injection and resolved chemosis and hypopyon in the anterior chambers. (D, E) Fundus photographs revealed mild vitreous opacity without focal abnormalities.


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