title: Pediatric endogenousHaemophilus influenzaeendophthalmitis with presumed hyposplenism.
abstract: BACKGROUND
  Endogenous bacterial endophthalmitis is a rare but potentially devastating intraocular infection that can have severe sight-threatening complications. Most patients with endogenous bacterial endophthalmitis have underlying infectious conditions, such as diabetes or malignancy, which predispose them to infection.
  
  
  METHODS
  A 1-year-old girl presented with cloudiness of the right eye. Ocular examination showed a cloudy cornea in the right eye with conjunctival injection and hypopyon. The intraocular pressure was 43 mmHg, and the fundus could not be visualized. She had an 8-day history of fever, and cerebrospinal fluid analysis showed typical findings of bacterial meningitis. She was clinically diagnosed with bacterial meningitis and endophthalmitis in the right eye and was treated with intravenous, topical, and intravitreal antibiotics and vitrectomy.Haemophilus influenzaewas isolated from the blood and cerebrospinal fluid cultures, but not from the aqueous and vitreous cultures. Four months later, her pediatrician diagnosedStreptococcus pneumoniaemeningitis, but she had no clinical signs of endophthalmitis. Seven years after the initial presentation, the best-corrected visual acuity was 20/40 in the right eye.
  
  
  CONCLUSIONS
  Endophthalmitis caused byH. influenzaeis generally associated with poor visual outcomes; however, the patient in the current case responded well to the treatment. The patient had recurrent bacterial meningitis caused byH. influenzaeandS. pneumoniaewithin a 4-month period. Magnetic resonance imaging was performed to search for underlying infectious causes and revealed that the patient had an extremely small spleen for her age. Because the spleen is critical for clearing encapsulated bacteria such asH. influenzaeorS. pneumoniae, we speculated that hyposplenism led to the bloodstream infection ofH. influenzaand then endogenous endophthalmitis in the right eye.
authors.affiliation: Department of Ophthalmology, Kurume University School of Medicine, Kurume, Japan.
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Haruta
authors.affiliation: Department of Ophthalmology, Kurume University School of Medicine, Kurume, Japan.
authors.forename: Yumiko
authors.initials: Y
authors.lastname: Yoshida
authors.affiliation: Department of Ophthalmology, Kurume University School of Medicine, Kurume, Japan.
authors.forename: Ryoji
authors.initials: R
authors.lastname: Yamakawa
keywords: Streptococcus pneumoniae; intravitreal antibiotics; meningitis; vitrectomy