Duong Tan, Shahbazi Shahin, Lee Sung
Internal Medicine Resident at Broward Health Medical Center in Fort Lauderdale, FL.
Internist in the Department of Hospital Medicine at the South Sacramento Medical Center in CA.
Perm J. 2018;22:17-081. doi: 10.7812/TPP/17-081.
Endogenous endophthalmitis is a rare condition that is caused by hematogenous spread of bacteria or fungi and is usually seen in patients with predisposed medical conditions. We are reporting an unusual case of group A streptococcal infection causing endogenous endophthalmitis and septic arthritis in a healthy 42-year-old man.
A previously healthy 42-year-old man presented to the Emergency Department with chills, fever, left wrist pain, left eye pain, and vision loss. Owing to the acute onset of the septic arthritis and the patient's bandemia, the Ophthalmology Department was consulted for suspicion of endophthalmitis. Blood cultures, left wrist synovial fluid cultures, and vitreous cultures grew group A streptococcus. An incision and drainage of the left wrist was performed, and intravitreal injection of vancomycin was given. The patient's vision was responsive only to light on discharge from the hospital. The patient underwent a left eye evisceration 2 months later.
Endophthalmitis provides a difficult diagnostic and therapeutic challenge. However, even with prompt treatment, visual outcomes may be poor.
内源性眼内炎是一种罕见的病症，由细菌或真菌的血行播散引起，通常见于有易感基础疾病的患者。我们报告一例不寻常的A组链球菌感染病例，该感染导致一名42岁健康男性发生内源性眼内炎和化脓性关节炎。
一名既往健康的42岁男性因寒战、发热、左手腕疼痛、左眼疼痛和视力丧失就诊于急诊科。由于化脓性关节炎急性起病且患者出现杆状菌血症，眼科会诊怀疑眼内炎。血培养、左手腕滑液培养和玻璃体培养均培养出A组链球菌。对左手腕进行了切开引流，并给予玻璃体内注射万古霉素。患者出院时视力仅对光有反应。2个月后患者接受了左眼眼球摘除术。
眼内炎在诊断和治疗方面都具有挑战性。然而，即使及时治疗，视力预后可能也很差。
