Endogenous Pseudomonas endophthalmitis in an immunocompetent patient.
OBJECTIVE
To report an unusual case of community-acquired Pseudomonas aeruginosa pneumonia in an immunocompetent host complicated by orbital cellulitis, panophthalmitis, and subcutaneous nodules.


METHODS
An otherwise healthy 47-year-old woman presented with a 24-hour history of fever, cutaneous nodules, right sided pleuritic chest pain, and eyelid edema with severe vision loss in her right eye. A chest X-ray demonstrated a homogeneous infiltrate in the right upper lobe. Ophthalmic examination revealed signs of metastatic orbital cellulitis and panophthalmitis. Culture specimens from blood, sputum, skin, and vitreous showed a significant growth of P. aeruginosa species.


RESULTS
Intravenous antibiotic therapy led to resolution of the pneumonia, cutaneous nodules, and orbital cellulitis. Despite intravitreal and topical antibiotics, the patient finally required enucleation.


CONCLUSIONS
This case represents a rare combination of manifestations in an immunocompetent patient with P. aeruginosa infection. It highlights the accelerated course that may result from P. aeruginosa infection, the difficulties of treatment, and the poor prognosis in the case of eye involvement.
Diaz-Valle
D
D
Department of Ophthalmology, Hospital Clinico San Carlos, Madrid, Spain. daviddiazvalle@yahoo.es
Benitez del Castillo
J M
JM
Fernandez Acenero
M J
MJ
Santos-Bueso
E
E
Martinez de la Casa
J M
JM
Garcia-Sanchez
J
J
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D001769:Blood / Q000382:microbiology; D002481:Cellulitis / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology; D004359:Drug Therapy, Combination; D009877:Endophthalmitis / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D015353:Eye Enucleation; D015818:Eye Infections, Bacterial / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D005260:Female; D006801:Humans; D007121:Immunocompetence; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D009916:Orbital Diseases / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology; D010202:Panophthalmitis / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology; D018410:Pneumonia, Bacterial / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D011552:Pseudomonas Infections / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D011550:Pseudomonas aeruginosa / Q000302:isolation & purification; D012867:Skin / Q000382:microbiology; D013183:Sputum / Q000382:microbiology
D000900:Anti-Bacterial Agents