title: Metastatic bacterial endophthalmitis. A report of four cases all leading to blindness.
abstract: OBJECTIVE
  To draw attention to the rare but severe entity of endophthalmitis as encountered due to metastatic spread of bacteria.
  
  
  METHODS
  We report our experience from four cases of metastatic bacterial endophthalmitis.
  
  
  RESULTS
  Systemic infection (Pneumococcus meningitis) was evident in two cases, but in the other two there was no early clue to systemic infection. Eventually, however, endocardial vegetations were disclosed as the source of bacterial emboli (E.coli, peptostreptococcus). In the most atypical patient, magnetic resonance scanning had indicated disseminated brain tumours, and only autopsy revealed the infectious nature of the disease. Ocular ultrasonography being part of the work-up, the four eyes under study all showed marked morphological intraocular changes, including 'solid tumour' in the presumed neoplastic case.
  
  
  CONCLUSIONS
  Our cases stress the severity of metastatic bacterial endophthalmitis and the easily missed early diagnosis, even where experienced clinicians are involved. The role of diagnostic ultrasound is discussed.
authors.affiliation: University Eye Clinic, Rigshospitalet, Copenhagen, Denmark.
authors.forename: Y
authors.initials: Y
authors.lastname: Piczenik
authors.forename: B
authors.initials: B
authors.lastname: Kjer
authors.forename: H C
authors.initials: HC
authors.lastname: Fledelius
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001424:Bacterial Infections; D001766:Blindness / Q000175:diagnosis / Q000209:etiology* / Q000382:microbiology*; D001932:Brain Neoplasms / Q000175:diagnosis; D003937:Diagnosis, Differential; D004699:Endocardium / Q000382:microbiology; D009877:Endophthalmitis / Q000150:complications* / Q000175:diagnosis / Q000382:microbiology*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008586:Meningitis, Pneumococcal; D014463:Ultrasonography