title: Bilateral endophthalmitis in a patient with bacterial meningitis caused by Streptococcus pneumoniae.
abstract: OBJECTIVE
  To present a patient who developed bilateral endogenous endophthalmitis secondary to Streptococcus pneumoniae meningitis.
  
  
  METHODS
  A 44-year-old man who was unconscious because of bacterial meningitis was referred to us for conjunctival hyperemia and decreased pupillary light reflexes. Ophthalmoscopy revealed inflammation in the anterior chamber and vitreous opacities in both eyes. He was diagnosed as having endogenous endophthalmitis associated with the meningitis. Ceftazidime and vancomycin hydrochloride were injected intravitreally and subconjunctivally repeatedly in both eyes.
  
  
  RESULTS
  Vision improved to 20/200 in the left eye 1 month later, but the right eye became hypotonic and blind. Vision deteriorated to light perception in the left eye due to a retinal detachment with proliferative vitreoretinopathy, and vitreous surgery successfully reattached the retina. Vision recovered to 20/80, and the retina has remained attached for 1 year.
  
  
  CONCLUSIONS
  We recommend that endogenous endophthalmitis be suspected in cases of meningitis, and if present, intravitreal and subconjunctival antibiotics should be promptly given to preserve vision.
authors.affiliation: Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan.
authors.forename: Hidemasa
authors.initials: H
authors.lastname: Torii
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Miyata
authors.forename: Eiko
authors.initials: E
authors.lastname: Sugisaka
authors.forename: Yuho
authors.initials: Y
authors.lastname: Ichikawa
authors.forename: Kei
authors.initials: K
authors.lastname: Shinoda
authors.forename: Makoto
authors.initials: M
authors.lastname: Inoue
mesh_terms: D000328:Adult; D000667:Ampicillin / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000382:microbiology; D002439:Cefotaxime / Q000627:therapeutic use; D002442:Ceftazidime / Q000627:therapeutic use; D002555:Cerebrospinal Fluid / Q000382:microbiology; D004359:Drug Therapy, Combination; D009877:Endophthalmitis / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D015818:Eye Infections, Bacterial / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D007839:Functional Laterality; D006801:Humans; D008297:Male; D008586:Meningitis, Pneumococcal / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D012163:Retinal Detachment / Q000209:etiology / Q000601:surgery; D012591:Scleral Buckling; D013296:Streptococcus pneumoniae / Q000302:isolation & purification*; D014640:Vancomycin / Q000627:therapeutic use; D014792:Visual Acuity; D014821:Vitrectomy; D018630:Vitreoretinopathy, Proliferative / Q000209:etiology / Q000601:surgery
chemical_list: D000900:Anti-Bacterial Agents; D014640:Vancomycin; D000667:Ampicillin; D002442:Ceftazidime; D002439:Cefotaxime