title: Bilateral acute endophthalmitis associated with munchausen syndrome.
abstract: OBJECTIVE
  Endophthalmitis is a potentially blinding intraocular infection that requires urgent intervention. Self-inflicted endophthalmitis is rare, difficult to diagnose, and requires a multidisciplinary approach for management. The purpose is to present a rare case of sequential self-inflicted acute endophthalmitis as a feature of Munchausen syndrome.
  
  
  METHODS
  This is a case report reviewing imaging and laboratory studies.
  
  
  RESULTS
  A 42-year-old female patient developed culture-proven acute endophthalmitis sequentially in both eyes with different bacterial strains. There was clear evidence of self-inflicted corneal puncture tracks in the right eye, and during the course of inpatient psychiatric evaluation, the patient admitted to self-inflicted ocular perforations.
  
  
  CONCLUSIONS
  Patients with Munchausen syndrome often injure themselves as a method of drawing attention, sympathy, or reassurance. Although ocular injuries due to psychiatric disease are known to occur, intraocular injection as a mode of self-injury is extremely rare. A high index of suspicion must be maintained when the reported history and clinical course are inconsistent.
authors: *Department of Ophthalmology, Beaumont Eye Institute, Royal Oak, Michigan; †Associated Retinal Consultants, Royal Oak, Michigan; ‡Department of Ophthalmology, W.K. Kellogg Eye Center, University of Michigan Medical School, Ann Arbor, Michigan; and §Department of Pathology, University of Michigan, Ann Arbor, Michigan.
authors: Prethy
authors: P
authors: Rao
authors: Ankoor R
authors: AR
authors: Shah
authors: Monica M
authors: MM
authors: Michelotti
authors: Bradley
authors: B
authors: Anderson
authors: Ashkan M
authors: AM
authors: Abbey
authors: Nieraj
authors: N
authors: Jain
authors: Lori
authors: L
authors: Stec
authors: Lori
authors: L
authors: Lowe
authors: Mark W
authors: MW
authors: Johnson
authors: George A
authors: GA
authors: Williams
mesh_terms: D000208:Acute Disease; D000328:Adult; D009877:Endophthalmitis / Q000175:diagnosis / Q000209:etiology*; D015818:Eye Infections, Bacterial / Q000175:diagnosis / Q000209:etiology*; D015807:Eye Injuries, Penetrating / Q000150:complications* / Q000175:diagnosis; D005260:Female; D006801:Humans; D009110:Munchausen Syndrome / Q000150:complications* / Q000523:psychology; D012652:Self Mutilation / Q000150:complications* / Q000523:psychology; D016728:Self-Injurious Behavior; D013290:Streptococcal Infections / Q000175:diagnosis / Q000209:etiology* / Q000382:microbiology; D041623:Tomography, Optical Coherence; D034363:Viridans Streptococci / Q000302:isolation & purification; D014822:Vitreous Body / Q000382:microbiology