Endogenous endophthalmitis is a devastating intraocular infection. Finding the primary infection and directed treatment is life-saving. We describe a 47-year-old man, with uncontrolled diabetes mellitus, who presented with two weeks history of progressive reduced vision and redness of the left eye (LE). He was generally unwell since a month, previously. Examination showed relative afferent pupillary defect (RAPD) in the affected eye and visual acuity was hand movement. There was moderate anterior chamber and vitreous reaction. Fundus examination showed a huge dome-shaped choroidal mass covering the entire macula. Diagnosis of severe endogenous endophthalmitis was made, with isolation of Enterobacter sp. from his blood culture. Meanwhile, he also had elevated inflammatory markers with presence of leucocytosis, neutrophilia and elevated erythrocyte sedimentation rate (ESR) as well as C-reactive protein (CRP). Vitreous tap and aqueous tap had no growth, He improved with combination of intravitreal and systemic antibiotic, as shown by the resolved fever and reduced inflammatory markers but progressive inflammation occluded the fundus details and the LE vision eventually became no projection of light despite treatment. Subsequently, he developed rubeotic glaucoma and was treated conservatively because the LE was painless with poor vision. The repeated blood culture and urine was normal. In conclusion, endogenous endophthalmitis with eventual panophthalmitis is difficult to treat and has very poor visual prognosis. Our case highlights the challenges faced in the management of vision-threatening endophthalmitis and panophthalmitis in this patient.
Severe Endogenous Endophthalmitis with Panophthalmitis-Lessons to Learn
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Endophthalmitis endogenous merupakan sejenis jangkitan mata serius yang biasanya berpunca daripada penyebaran kuman dari anggota badan lain ke dalam mata melalui darah pesakit. Usaha untuk mencari punca utama jangkitan dan memulakan rawatan serta-merta adalah sangat penting untuk menyelamatkan nyawa dan penglihatan pesakit. Laporan kes ini adalah berkenaan seorang lelaki yang berumur 47 tahun yang kedua-dua matanya mengalami kehilangan penglihatan secara progresif dan kemerahan mata kiri sejak dua minggu lepas. Mata kiri adalah mata yang lebih teruk dan penglihatan mata kiri hanya dapat melihat pergerakan tangan. Pemeriksaan mata kiri menunjukkan koleksi nanah yang besar dalam lapisan koroid di bahagian makula. Diagnosis endogenous endophthalmitis telah dibuat berdasarkan sejarah yang diberi oleh pesakit berkenaan, bersama penyiasatan darah pesakit dan pengimejan mata seperti Enterobacter sp. yang diisolasikan dari kultur darah, ultrasound B-scan dan contrasted enhanced computerized tomography (CECT) untuk mata dan kepala. Keadaan pesakit bertambah baik dari segi kehilangan demam, keputusan darah, dan ultrasound B-scan, selepas rawatan antibiotik yang diberikan secara intravitreal dan systemik. Tetapi keradangan mata yang berlarutan telah mengaburkan butiran fundus mata kiri. Malangnya, pesakit mengalami glaukoma rubeotik dan dirawat secara konservatif. Kesimpulannya, endogenous endophthalmitis dapat menyebabkan panophthalmitis dan sukar untuk dirawati. Laporan kes ini ingin menitik-beratkan cabaran-cabaran yang dihadapi sepanjang perawatan pesakit yang mengalami endophthalmitis.
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