Título / Title

BILATERAL METASTATIC ENDOPHTHALMITIS ASSOCIATED WITH SUBRETINAL ABSCESS CAUSED BY PSEUDOMONAS – A CASE REPORT

Introdução / Purpose

The objective was to describe a bilateral metastatic ocular infection in a patient with bronchiectasis colonization by pseudomonas, developing non-simultaneous bilateral subretinal abscess.

Material e Método / Methods

Review of medical records

Resultados / Results

A 54-year-old female patient, with arterial hypertension, type 2 diabetes and a history of idiopathic bronchiectasis, with frequent episodes of infectious bronchopneumonia was referred to our ophthalmologic emergency department with pain and low visual acuity in the left eye. VA of 0.7 OD and absence of light perception OS. She showed periorbital edema, ciliary injection, corneal edema 2+, 1mm hyphema and fibrin in the anterior chamber, associated with rubeosis iridis, IOP was 16 OD and 32 OS. Radiological and clinical diagnosis of orbital cellulitis with evidence of spontaneous scleral perforation and neovascular glaucoma in the left eye. She was hospitalized, introduced systemic antibiotics. Performed evisceration of the left eye with good clinical improvement. Anatomopathologal analysis compatible with chronic endophthalmitis. After 10 days, the patient presented the same symptoms in the contralateral eye. VA of 0.3, vitritis 1+ and elevated subretinal, granulomatous-like, yellowish-white lesion in the nasal sector, with 2 diameters of papilla. All serological and rheumatological tests were negative, including blood culture. Sputum cultures, facial sinuses and bronchoalveolar lavage were positive for multi-resistant Pseudomonas aeruginosa. There was clinical deterioration despite the use of systemic antibiotic therapy. Posterior vitrectomy with intravitreal injection was performed. Microbiological test was positive for Pseudomonas aeruginosa. Patient progressed with scleral melting and periocular abscess. Performed enucleation with clinical improvement after.

Discussão e Conclusões / Conclusion

Endogenous endophthalmitis by pseudomonas has a poor prognosis. Immediate recognition of this condition could increase visual outcome and prevent systemic spread.

Palavras Chave

Endogenous endophthalmitis. Pseudomonas aeruginosa. bronchiectasis