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

• Kim SJ
• Seo SW
• Park JM
• Chung IY

• KMID: 754774
• DOI: http://doi.org/10.3341/kjo.2009.23.4.321

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.

Reference

1. Greenwald MJ, Wohl LG, Sell CH. Metastatic bacterial endophthalmitis: a contemporary reappraisal. Surv Ophthalmol. 1986. 31:81–101.

2. Farber BP, Weinbaum DL, Dummer JS. Metastatic bacterial endophthalmitis. Arch Intern Med. 1985. 145:62–64.

3. Barnard T, Das A, Hickey S. Bilateral Endophthalmitis as an initial presentation in meningococcal meningitis. Arch Ophthalmol. 1997. 115:1472–1473.

4. Bohigian GM, Olk RJ. Factors associated with a poor visual result in endophthalmitis. Am J Ophthalmol. 1986. 101:332–341.

5. Oada AA, Johnson RP, Liles WC, et al. Endogenous bacterial endophthalmitis: report of a ten-year retrospective study. Ophthalmology. 1994. 101:832–838.

6. Puliafito CA, Baker AS, Haaf J, Foster CS. Infectious endophthalmitis: review of 36 cases. Ophthalmology. 1982. 89:921–929.

7. Ness T. Endogene endophthalmitis. Ophthalmologe. 2007. 104:935–939.

8. Cohen P, Kirshner J, Whiting G. Bacterial endogenous Escherichia coli endophthalmitis. Arch Intern Med. 1980. 140:1088–1089.

9. Wong JS, Balakrishnan V. Neisseria meningitidis endogenous endophthalmitis: case report and literature review. J Pdeiatr Ophthalmol Strabismus. 1999. 36:145–152.

10. Kaufman B, Levy H, Zaleznak BD, Litvak AM. Stastistical analysis of 242 cases of meningococcus meningitis. J Pediatr. 1951. 38:705–716.

11. Beeson PB, Westerman E. Cerebrospinal fever: analysis of 3575 case reports, with special reference to sulphonamide therapy. Br Med J. 1943. 1:497–500.

12. Jubb AA. Chemotherapy and serotherapy in cerebrospinal (meningococcal) meningitis: an analysis of 3206 case reports. Br Med J. 1943. 1:501–504.

13. Harres GE. Cerebrospinal fever: a review of 500 cases treated by chemotherapy without intrathecal serum. Br Med J. 1942. 2:423–425.

14. Bradley WG, Daroff RB, Fenichel GM, Jankovic J. Neurology in Clinical Pratice. 2008. Vol 2:5th ed. Philadelphia: Butterworth-Heinemann Elesevier;1419–1451.

15. Auerbach SB, Leach CT, Bateman BJ, et al. Meningococcal en dophthalmitis without concomitant septicemia or meningitis. Pediatr Infect Dis J. 1989. 8:411–413.

16. Kearns AM, Sprott MS. Endophthalmitis caused by Neisseria meningitides. J Infect. 1991. 22:299–300.

17. Beynon HLC, Hague S. Meningococcal endophthalmitis and pericarditis. J R Soc Med. 1990. 83:331.

18. Kerkhoff FT, van der Zee A, Bergmans AM, Rothova A. Polymerase chain reaction detection of Neisseria meningitidis in the intraocular fluid of a patient with endogenous endophthalmitis but without associated meningitis. Ophthalmology. 2003. 110:2134–2136.

19. Gonzalez GA, Whitcher JP, Irvine AR, O'Brien JM. A ring hypopyon in a patient with meningococcal endophthalmitis: a case report and review of the literature. J Pediatr Ophthalmol Strabismus. 1998. 35:329–333.

20. Song JH, Chung IY, Park JM. A case of bilateral endogenous enterococcus faecalis endophthalmitis in liver abscess. J Korean Ophthalmol Soc. 2007. 48:1291–1296.

21. Park HR, Youn YH, Sohn JH. Endogenous nocardial endophthalmitis in a renal transplant recipient. J Korean Ophthalmol Soc. 2003. 44:998–1001.