[Ocular manifestation of an infectious endocarditis].

BACKGROUND

Infectious infiltrations of the retina and the vitreous in endogenous infections such as septicaemia are rare.

PATIENT

A 42-year-old woman presented complaining about a defect of her visual field in the right eye. The patient reported about a feeling of illness and high temperature up to 39.5 degrees C since two weeks.

RESULTS

At the first examination the patient had a best corrected visual acuity of 1.25 in her right eye and 1.0 in her left eye. A focal infiltration of the retina with a circumscribed haemorrhage was found on ophthalmoscopy and fluorescein angiography, located on the temporal superior vein. One day later a circumscribed vitreous infiltration was seen in this area. The ophthalmological findings and the fever of unknown origin led to the tentative diagnosis of a retinal infiltration due to an infectious disease. Internal examinations revealed a subacute endocarditis caused by viridans streptococci. Under intravenous antibiotic treatment the infiltration of the retina and vitreous declined quickly. A complete healing of the ophthalmological findings was found 3 weeks later.

CONCLUSIONS

Since the subacute endocarditis in infections caused by viridans streptococci is characterized by a lingering start of the disease with high temperature of unknown origin and an unspecific feeling of illness, the ophthalmological findings can manifest itself before the diagnosis of the underlying disease is made. Complications such as blindness after fulminant endophthalmitis and death can be avoided through quick diagnosis and treatment.