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前列腺脓肿继发的内源性眼内炎

Endogenous Endophthalmitis Secondary to Prostate Abscess.

作者信息

Saleh Nada A, Patel Shreeker, Quadri Syed

机构信息

Internal Medicine, Javon Bea Hospital, Rockford, USA.

Internal Medicine, University of Illinois, Rockford, USA.

出版信息

Cureus. 2025 May 25;17(5):e84765. doi: 10.7759/cureus.84765. eCollection 2025 May.

Abstract

Endophthalmitis is a severe ophthalmic emergency that necessitates immediate intervention. Most cases are exogenous, originating from eye surgeries, intravitreal injections, or penetrating injuries. Endogenous endophthalmitis occurs when the infection is spread hematogenously, usually as a result of bacteremia. We present a healthy individual with no predisposing factors who presented to the emergency department with decreased left vision.  A male in his late sixties with a medical history of hypertension and hyperlipidemia presented to the ophthalmology clinic with complaints of left eye pain, redness, and decreased vision. Diagnosis of endogenous endophthalmitis was made through fundoscopy, and the patient received intravitreal injections of vancomycin and ceftazidime in the left eye. He was subsequently admitted to the hospital, where blood and urine cultures grew methicillin-resistant Staphylococcus aureus (MRSA). Upon further investigation, the patient reported experiencing obstructive urinary symptoms, prompting the initiation of intravenous (IV) vancomycin and linezolid. CT of the abdomen and pelvis revealed multiple prostatic abscesses. During treatment, the patient's vision gradually improved, and he was discharged with IV antibiotics. This case emphasizes the importance of prompt diagnosis and treatment in managing this ophthalmologic emergency. A thorough review of systems was essential in identifying the source of bacteremia, enabling timely intervention. We describe the role of magnetic resonance imaging in diagnosing endophthalmitis and highlight the treatment modalities.

摘要

眼内炎是一种严重的眼科急症,需要立即进行干预。大多数病例为外源性,源于眼部手术、玻璃体内注射或穿透性损伤。内源性眼内炎是指感染通过血行传播,通常是菌血症的结果。我们报告一例无易感因素的健康个体,因左眼视力下降就诊于急诊科。一名60多岁的男性,有高血压和高脂血症病史,因左眼疼痛、发红和视力下降就诊于眼科门诊。通过眼底镜检查诊断为内源性眼内炎,患者左眼接受了玻璃体内注射万古霉素和头孢他啶。随后他被收入院,血培养和尿培养均培养出耐甲氧西林金黄色葡萄球菌(MRSA)。进一步检查时,患者报告有排尿梗阻症状,于是开始静脉注射万古霉素和利奈唑胺。腹部和盆腔CT显示多个前列腺脓肿。治疗期间,患者视力逐渐改善,出院时带静脉用抗生素。该病例强调了在处理这种眼科急症时及时诊断和治疗的重要性。全面的系统回顾对于确定菌血症来源至关重要,从而能够及时进行干预。我们描述了磁共振成像在诊断眼内炎中的作用,并强调了治疗方式。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a7fe/12186464/6ad9f1f87c82/cureus-0017-00000084765-i01.jpg

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