Author: Nataliia Bondar (Ukraine)
Co-authors: Igor Svystunov, Tatiana Krasnovid, Oksana Sidak-Petretska
Purpose
To present a rare case of endophthalmitis secondary to gonococcal sepsis, and to highlight its clinical features.
Setting/Venue
Patient’s history was significant for acute suppurative gonococcal prostatitis (with acute retention of urine, and severe sepsis with liver abscess, and suppurative tonsillitis), for which he had been treated as an in-patient at the Department of Urology of the city hospital. In addition, he had suppurative blepharitis of the left eye. A week after he was discharged from the Department of Urology, he was hospitalized to the Department of Ocular Trauma of the Filatov institute with the diagnosis of endophthalmitis in the left eye.
Methods
Visual acuity assessment, comprehensive eye examination, and microbiological examination. The left eye looked inflamed with mixed conjunctival injection. Other objective examination findings in the left eye included a clear cornea; moderately shallow and clear anterior chamber; abnormal iris color; circular posterior synechia; rigid pupil; lens haze; anterior lens capsule vascularity; and dim reflex. The right eye was quiescent. Other objective examination findings in the right eye included a clear and bright cornea; moderately shallow and clear anterior chamber; clear lens; pink reflex; pale pink optic disc with clear margins; and attached retina. Patient’s visual acuity was 0 OS and 1.0 OD. In addition, intraocular pressure (IOP) measured by pneumotometry was 14.0 mmHg (with dorzotymol plus Brimonal 0.2% twice daily) OS, and IOP measured by palpation was normal OD. Ocular ultrasound findings included severe preretinal vitreous fibrosis, chorioretinal edema (suspected ciliary body and choroidal detachment), optic disc cupping and attached retina in the left eye. The patient received conservative treatment, including Azithromycin, 500 mg daily; Levofloxacin, 500 mg daily; Melbek, 15 mg i/m; Dexalgin, 25 mg i/m; Dorzotymol ophthalmic solution; Brimonal ophthalmic solution 0.2%; Vigamox ophthalmic solution 0.5%; Oftaquix ophthalmic solution 0.5%; Uniclophen ophthalmic solution 0.1%; and Floxal ophthalmic ointment.
Results
The patient poorly responded to treatment, and clinical manifestations of endophthalmitis were becoming more and more severe. He underwent evisceration of the left eye. The patient’s postoperative period was unremarkable. A week after surgery, in the left eye, the conjunctival cavity was clear, and conjunctival sutures were clear, there was no edema, and the stump was movable in all directions. An ocular prosthesis was fitted in the orbit (Fig. 2). There was no bacterial growth in conjunctival samples.
Conlusions
We presented a rare case of disseminated gonococcal infection complicated by severe sepsis with liver abscess, suppurative tonsillitis, and suppurative blepharitis of the left eye leading to endopthalmitis, with subsequent evisceration. Gonococcal ocular lesions are associated with late presentation to the ophthalmologist, fast endophthalmitis development, and asymmetric involvement, but no corneal involvement. Consultations of allied health professionals and multiprofessional management of gonorrhea patients are required to prevent complications in various organs and systems should gonococcal sepsis develop.
Financial Disclosure
Presenting author and co-authors have not a financial interest in the subject matter and don't receive money from any mentioned company.
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