Bilateral enucleation due to multi-bacterial fulminant endogenous panophthalmitis

• Published in: Archivos de la Sociedad Española de Oftalmología (English ed.) 2020-01, Vol.95 (1), p.34-37
• Main Authors: Chaparro Tapias, T.A., Rangel Gualdron, C.M., Rodriguez, H.A., Rodriguez, L.M., Flores de los Reyes, L., Sánchez España, J.C.
• Format: Article
• Language: English
• Subjects: Anti-Bacterial Agents - therapeutic use; Bacteraemia; Bacteriemia; Candida magnolia; Candida magnoliae; Candidiasis - microbiology; Candidiasis - surgery; Coinfection - surgery; Combined Modality Therapy; Corneal Perforation - etiology; Disease Progression; Enucleación; Eye Enucleation; Female; Humans; Klebsiella Infections - microbiology; Klebsiella Infections - surgery; Klebsiella pneumoniae; Klebsiella pneumoniae - isolation & purification; Middle Aged; Orbital Cellulitis - drug therapy; Orbital Cellulitis - surgery; Panoftalmitis; Panophthalmitis; Panophthalmitis - drug therapy; Panophthalmitis - surgery
• ISSN: 2173-5794; 2173-5794
• DOI: 10.1016/j.oftale.2019.10.002

The case is presented of a 62 year-old woman with a rapid, progressive bilateral decrease in visual acuity and panuveitis with orbital cellulitis. She was also in poor general condition, with emesis and fever. Septicaemia due to Klebsiella pneumoniae and bilateral endogenous panophthalmitis were diagnosed. The ocular infection quickly progressed to sclerokeratitis and bilateral perforation despite broad spectrum systemic antibiotic management, and eventually the patient required bilateral enucleation. Microbiological cultures of the surgical pieces identified Klebsiella pneumoniae and Candida magnoliae. To our knowledge, this is the third published case that required bilateral enucleation or evisceration due to endogenous panophthalmitis, and the first case of endogenous ocular infection caused by Candida magnoliae. Mujer de 62 años con disminución de la agudeza visual bilateral rápidamente progresiva y panuveítis con celulitis orbitaria, asociado a mal estado general, emesis y fiebre. Se diagnosticó septicemia por Klebsiella pneumoniae y panoftalmitis endógena bilateral. La afectación ocular progresó rápidamente a escleroqueratitis y perforación en ambos ojos pese a recibir manejo antibiótico sistémico de amplio espectro. Finalmente, la paciente requirió enucleación bilateral. Los cultivos microbiológicos de las piezas quirúrgicas identificaron Klebsiella Pneumoniae y Candida Magnoliae. De acuerdo con nuestro conocimiento, es el tercer caso publicado que haya requerido enucleación o evisceración bilateral por panoftalmitis endógena y el primer caso de infección ocular endógena causada por Candida Magnoliae.