Bilateral endophthalmitis in a patient with bacterial meningitis caused by Streptococcus pneumoniae.
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.
Torii
Hidemasa
H
Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan.
Miyata
Hiroshi
H
Sugisaka
Eiko
E
Ichikawa
Yuho
Y
Shinoda
Kei
K
Inoue
Makoto
M
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
D000900:Anti-Bacterial Agents; D014640:Vancomycin; D000667:Ampicillin; D002442:Ceftazidime; D002439:Cefotaxime