title: Perforated corneal ulcer with subsequent endophthalmitis in a patient with graft-versus-host disease.
abstract: OBJECTIVE
  To describe a case of a perforated corneal ulcer leading to a bacterial endophthalmitis in a patient with graft-versus-host disease (GVHD).
  
  
  METHODS
  Clinical history and examination; slit-lamp photography; surgical intervention; laboratory evaluation including microbiology, polymerase chain reaction (PCR), flow cytometry, and cytopathology.
  
  
  RESULTS
  A diagnostic and therapeutic pars plana vitrectomy was performed. The vitreous aspirate was evaluated with microbiology; PCR for herpes simplex, herpes zoster, and cytomegalovirus; flow cytometry; and cytopathology. The patient received intravitreal antibiotics and antifungal and antiviral medication. The vitreous culture grew Staphylococcus epidermidis.
  
  
  CONCLUSIONS
  Patients with GVHD are at risk for corneal ulcers with subsequent perforation. Commensal ocular flora may seed the vitreous and cause an endophthalmitis. Patients with GVHD may develop a vitritis from many causes including viral, fungal, and bacterial etiologies or a relapse of their original disease. When patients with GVHD present with vitritis, consideration should be given to obtaining a large vitreous aspirate to establish the etiology.
authors.affiliation: Kresge Eye Institute, Department of Ophthalmology, Detroit, MI, USA.
authors.forename: Sean D
authors.initials: SD
authors.lastname: Adrean
authors.forename: James E
authors.initials: JE
authors.lastname: Puklin
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016026:Bone Marrow Transplantation; D003320:Corneal Ulcer / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D004359:Drug Therapy, Combination; D009877:Endophthalmitis / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D015818:Eye Infections, Bacterial / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D006086:Graft vs Host Disease / Q000150:complications*; D006801:Humans; D015473:Leukemia, Promyelocytic, Acute / Q000628:therapy; D008297:Male; D008875:Middle Aged; D012422:Rupture, Spontaneous; D013203:Staphylococcal Infections / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D013212:Staphylococcus epidermidis / Q000302:isolation & purification*; D014822:Vitreous Body / Q000382:microbiology
chemical_list: D000900:Anti-Bacterial Agents