Title

BILATERAL ENDOGENOUS ENDOPHTHALMITIS ASSOCIATED WITH INFECTIVE ENDOCARDITIS

Summary

A 57-year-old male patient presents at the emergency room with a progressive and painless low visual acuity in both eyes that started 4 days ago. The patient has no past ocular history or other systemic comorbidities, he started treatment for urinary tract infection 4 days ago in another service. The ophthalmologic examination shows visual acuity of counting fingers at 1 meter in the right eye and 20/200 in the left eye, with conjunctival hyperemia and anterior camera reaction in both eyes. The fundoscopy showed important vitreitis in both eyes, being hard to see fundus details of the right eye due to media opacities, in the left eye there is an atrophic lesion with exsudation in the inferior temporal arcade, with hard exsudates in the macula with areas of intraretinal hemorrhage. A bilateral panuveitis was suspected, and blood and imaging tests were requested. The patient had a blood pressure of 82x64 mmHg, blood glucose of 811mg/dL, respiratory rate of 36, leukocytes of 22400 and PCR of 239, positive blood culture for MRSA. Patient was hospitalized due to hyperglicemic hyperosmolar state and to investigate sepsis primary site. The transesophageal echocardiogram revealed an endocarditis focus and was started intravenous vancomycin therapy for 30 days. The patient showed visual acuity improvement after one month, presenting 20/25 in both eyes, with regression of the fundus lesions.

Area

CLINICAL CASE

Authors

Felipe Muralha, Gabriel Murad, Mariana Batista