Metastatic endophthalmitis combined with subretinal abscess in a patient with diabetes mellitus--a case report.
BACKGROUND
Endogenous endophthalmitis, extra-hepatic metastasis from liver abscess with diabetes mellitus, could lead to a devastating outcome without a prompt and appropriate management. We report a case of metastatic endophthalmitis combined with subretinal abscess with successful visual outcome after treatment.


METHODS
A 56-year-old male patient with diabetes mellitus under poor control presented to our emergency room with fever, sore throat, cough and poor appetite for 2 weeks. Abdominal computed tomography showed a 2.2 × 2.0 cm liver abscess. During hospitalization, sudden onset of blurred vision with floaters in his left eye was noted. Meanwhile, Brain computed tomography demonstrated subdural abscess in right parietal area. With obvious vitritis, a localized subretinal abscess was also found over temporal arcade with size about four disc areas under indirect ophthalmoscopy. A pars plana vitrectomy with intravitreal injection of ceftazidime (2 mg/0.1 ml) and amikacin (0.4 mg/0.1 ml) was performed without retinectomy. The margin of the subretinal abscess became firm and the central area resolved after the operation. Finally, his vision improved to 6/6 after cataract surgery.


CONCLUSIONS
Subretinal abscess is an extremely rare presentation of metastatic endophthalmitis. It is difficult to develop appropriate treatment guidelines of endophthalmitis complicated with subretinal abscess. Our experience in this case demonstrated if the size of the subretinal abscess is smaller than four disc areas, pars plana vitrectomy with intravitreal injection of antibiotics without retinectomy could be considered to avoid further retinal detachment.
Department of Ophthalmology, Chi Mei Medical Center, No.901, Zhonghua Rd., Yongkang Dist., Tainan City, 710, Taiwan. tzh0215@gmail.com.
Tsung-Han
TH
Tsai
Department of Ophthalmology, Chi Mei Medical Center, No.901, Zhonghua Rd., Yongkang Dist., Tainan City, 710, Taiwan. kailing65@gmail.com.
Kai-Ling
KL
Peng
D000038:Abscess / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D000583:Amikacin / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D002442:Ceftazidime / Q000627:therapeutic use; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D004359:Drug Therapy, Combination; D009877:Endophthalmitis / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D020802:Epidural Abscess / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology; D015818:Eye Infections, Bacterial / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D006801:Humans; D058449:Intravitreal Injections; D008297:Male; D008875:Middle Aged; D012164:Retinal Diseases / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D014057:Tomography, X-Ray Computed; D014821:Vitrectomy
D000900:Anti-Bacterial Agents; D000583:Amikacin; D002442:Ceftazidime