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

Min Soo Lee; Moo Hwan Chang

doi:10.3341/jkos.2013.54.2.370

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Lee and Chang: A Case of Bilateral Endogenous Endophthalmitis in a Streptococcus pneumoniae Meningitis Patient

Original Article

J Korean Ophthalmol Soc 2007;54(2):370-374.

Published online: 24 August 2007

DOI: https://doi.org/10.3341/jkos.2013.54.2.370

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

Min Soo Lee, MD, Moo Hwan Chang, MD, PhD

Department of Ophthalmology, Dankook University Medical College, Seoul, Korea

Address reprint requests to Moo Hwan Chang, MD, PhD Department of Ophthalmology, Dankook University Hospital #201 Manghyang-ro, Dongnam-gu, Cheonan 330-715, Korea Tel: 82-41-550-6497, Fax: 82-41-551-0137, E-mail: changmh@dankook.ac.kr

Received 7 July 201229 August 2012 Accepted 24 January 2013

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: Endogenous endophthalmitis, Meningitis, Streptococcus pneumoniae

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Figure 1.

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

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.

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.

Figure 4.

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

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.

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