Bilateral anterior uveitis in a patient with bacterial meningitis.
We report a case of bilateral iridocyclitis accompanied by bacterial meningitis in an immunocompetent patient. Case report. A 48 year-old healthy female visited our hospital with strong headache, fever, bilateral hyperemia, and blurred vision in both eyes. A slit-lamp examination revealed moderate cells and flare in the anterior chamber of both eyes, with fine keratoprecipitates. There were no obvious inflammatory changes in the vitreous, retina, and optic disc of both eyes. Elevation of peripheral blood white blood cells, C-reactive protein, and an elevated number of cerebrospinal fluid (CSF) cells suggested bacterial meningitis. The patient was admitted to our hospital and received intravenous antibiotics. Finally, a CSF culture revealed infection with gram-positive rods, suspected Listeria monocytogenes, confirming bacterial meningitis. For iridocyclitis, we prescribed betamethasone eyedrops and 0.5 % tropicamide eyedrops with intravenous adminstration of systemic antibiotics. 3 days later, her headache and bilateral hyperemia disappeared. This case is better described as sterile reactive uveitis rather than endogenous bacterial endophthalmitis, because bilateral anterior uveitis was resolved without chronic uveitis, iris atrophy, and vitreous opacity. When clinicians see patients with meningitis and bilateral anterior uveitis, sterile reactive uveitis should be considered in the differential diagnosis of uveitis.
Department of Ophthalmology, The University of Tokyo Graduate School of Medicine, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan. hhrpfb@yahoo.co.jp
Kazuyoshi
K
Otomo
Toshikatsu
T
Kaburaki
Takashi
T
Shigeeda
Mituko
M
Takamoto
Hidetoshi
H
Kawashima
Makoto
M
Araie
D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D015863:Iridocyclitis / Q000175:diagnosis / Q000382:microbiology*; D008089:Listeria monocytogenes / Q000302:isolation & purification*; D008088:Listeriosis / Q000150:complications / Q000175:diagnosis*; D016920:Meningitis, Bacterial / Q000150:complications* / Q000175:diagnosis; D008875:Middle Aged; D014606:Uveitis, Anterior / Q000175:diagnosis / Q000382:microbiology*