Author: Ismael Bakkali El Bakkali (Spain)
Co-authors: Guillermo Pérez Rivasés, Ana Boned Murillo, María Dolores Díaz Barreda, Isabel Bartolomé Sesé, Isabel Pinilla Lozano, Francisco Javier Ascaso Puyuelo
Purpose
We present a case of visual loss as the first manifestation of an infective endocarditis, in order to describe the importance of a detailed systemic examination after ophthalmic signs.
Setting/Venue
Ophthalmic symptoms could reflect clinical manifestation of systemic diseases. Ophthalmologists need to be alerted to discover uncommon diseases which debut as visual loss or any sign in fundus examination.
Methods
A 67-year-old male was admitted in the ER complaining blurred vision in his left eye during 10 days, associated with 40ºC fever and intense fatigue. He also referred spots and painful nodules on both hands and feet. We underwent a complete clinical examination. Visual acuity was 20/20 in the right eye and 20/40 in the left eye. Slit-lamp examination was unremarkable, as well as the intraocular pressure, which was 12 mmHg in both eyes. Fundoscopy and retinography were normal in the right eye; his left eye showed peripheral retinal microhemorrhages associated with vitreous opacities.
Results
The microhemorrhages observed in the fundoscopy matched with retinal Roth’s spots. The association of fever, fatigue, skin lesions and Roth’s spots suggested an infective endocarditis as a first diagnosis. The patient was admitted to internal medicine, where he had blood analytics and cultures performed, showing 18000 leukocytes with neutrophilia and positiveness to Staphylococcus aureus. An echocardiography confirmed the diagnosis of infective endocarditis.
Conlusions
Infective endocarditis is an infection of the inner heart’s surface that can produce septic emboli, leading to severe complications such as retinal hemorrhages with vision loss, brain strokes and other fatal complications. It is crucial to suspect it when an acute unilateral vision loss is associated with systemic symptoms such as fever, fatigue and skin lesions. Although not being pathognomonic, Roth’s spots are strongly associated with infective endocarditis. A rapid diagnosis may improve the patients’ prognosis and avoid eventual fatal complications.
Financial Disclosure
None
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