Endogenous Endophthalmitis Due to Escherichia coli: Case Report and Review

Endogenous endophthalmitis is a rare complication of Esche­ richia coli septicemia in the antibiotic era. Emphysematous en­ dophthalmitis due to E. coli is even more uncommon; only one case in a diabetic patient has been reported previously [1]. Herein, we describe a case ofendogenous emphysematous endophthalmitis due to E. coli in a patient with urinary tract infection and endocardi­ tis who did not have any medical history of diabetes mellitus. A 50-year-old man was hospitalized on 2 April 1994 because of a 10-day history of fever, chills, and ocular pain followed by loss of vision in both eyes. He had no history of ocular trauma or surgery. In 1993, he had undergone aortic valvuloplasty because of aortic stenosis. Three years before hospitalization, he had also had a left kidney stone and had received extracorporeal shock wave lithotripsy. He had no medical history of diabetes mellitus. Ten days before his admission, the patient had high fever, chills, and ocular pain. Erythematous change in both eyes was noted, and he complained of bilateral visual impairment during the following 2 days. He was treated with intravenous antibiotics (including amikacin) in a local medical clinic for the presumptive diagnosis of sepsis and endophthalmitis. A series of studies were done. Uri­ nalysis showed pyuria, and cultures ofurine and blood both yielded E. coli. He was later transferred to Taichung Veterans General Hospital (Taichung, Taiwan, ROC) because of deterioration of his clinical condition. At the time ofadmission, he was acutely ill-looking and drowsy. The temperature was 37°C, the blood pressure was 110/60 mm Hg, and the pulse rate was 76. Physical examination disclosed a grade 3/6 systolic murmur; the murmur was heard best at the aortic area and left sternal border, and the sound transmitted to the neck. Ophthalmologic examination showed bilateral periorbital swelling and moderate injected conjunctivae. Vision in both eyes was only light perception. The cornea of both eyes had an epithelial defect with superficial stromal haziness of the lower portion. Exudate and fibrinous material were present in the bilateral anterior cham­ bers, and there was mild opacity in the lenses of both eyes. The vitreous and fundi of both eyes could not be visualized. The other findings of the physical examination were unremarkable. ACT ofthe orbits demonstrated a gas bubble in the left eye globe, a finding indicating emphysematous endophthalmitis. The chest roent­ genogram obtained on admission did not show any abnormalities. Echographic examination of the heart revealed a vegetation over the tricuspid septal leaflet, with aortic stenosis, aortic regurgitation, and minimal pericardial effusion. An abdominal sonogram demonstrated left renal stones with cysts over both kidneys. Laboratory studies