School of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Miyagi, Japan.
Division of Emergency and Disaster Medicine, Tohoku Medical and Pharmaceutical University Hospital, Sendai, Miyagi, Japan.
Medicine (Baltimore). 2024 Jul 26;103(30):e39096. doi: 10.1097/MD.0000000000039096.
Endogenous endophthalmitis is a rare disease caused by hematogenous intraocular metastasis of bacteria from an infectious source. Diagnosing endogenous endophthalmitis is challenging for non-ophthalmologists. However, ophthalmic diseases can cause irreversible vision loss, making prompt diagnosis and treatment critical. Here we present a rare case of endogenous endophthalmitis initially misdiagnosed as a cataract.
An 84-year-old Japanese man presented to the emergency department with fever and dysmotility. The patient was aware of a left subconjunctival hemorrhage and cloudy cornea upon arrival at the hospital, but he misunderstood it as a fall-induced subconjunctival hemorrhage and age-related cataracts.
On the day following admission, petechial hemorrhage on the eyelid conjunctiva and the detection of Streptococcus mitis in the blood culture results led us to suspect endophthalmitis rather than cataracts. A definitive diagnosis of endophthalmitis was made through ophthalmologic examinations, and endophthalmitis was considered secondary to endocarditis.
Subsequently, antimicrobial treatment was continued.
However, the patient developed myocardial infarction and died on the ninth day of hospitalization.
Two important lessons were learned from the examination of this case of endogenous endophthalmitis caused by S mitis. First, endophthalmitis and cataracts can be misdiagnosed. Because the symptoms of endophthalmitis and cataracts, such as decreased vision, photophobia, and blurred vision, are similar, the eye must be cautiously examined. Second, endocarditis caused by S mitis may lead to endogenous endophthalmitis. Although S mitis is not pathogenic, endogenous endophthalmitis may occur in patients with certain risk factors, such as older age, cancer, and immunosuppression.
内源性眼内炎是一种罕见的疾病，由细菌从感染源经血源性眼内转移引起。非眼科医生诊断内源性眼内炎具有挑战性。然而，眼部疾病可导致不可逆转的视力丧失，因此及时诊断和治疗至关重要。在此，我们报告了一例最初误诊为白内障的内源性眼内炎罕见病例。
一名 84 岁的日本男性因发热和运动障碍到急诊科就诊。患者入院时发现左眼球结膜下出血和角膜混浊，但他误认为是跌倒引起的球结膜下出血和年龄相关性白内障。
入院后第二天，发现眼睑结膜出现瘀点样出血，血培养结果检出缓症链球菌，我们怀疑为眼内炎，而非白内障。通过眼科检查明确诊断为眼内炎，考虑为心内膜炎继发眼内炎。
随后继续进行抗感染治疗。
然而，患者发生心肌梗死并于住院第 9 天死亡。
从该例缓症链球菌引起的内源性眼内炎的检查中吸取了两个重要教训。首先，眼内炎和白内障可能被误诊。由于眼内炎和白内障的症状（如视力下降、畏光和视物模糊）相似，必须仔细检查眼睛。其次，缓症链球菌引起的心内膜炎可能导致内源性眼内炎。虽然缓症链球菌没有致病性，但在某些具有特定风险因素的患者（如年龄较大、癌症和免疫抑制）中可能发生内源性眼内炎。
