Endogenous Endophthalmitis in a Patient with Colorectal Cancer: A Case Report

Case Report

Austin Ophthalmol. 2023; 7(2): 1049.

Endogenous Endophthalmitis in a Patient with Colorectal Cancer: A Case Report

Homaide S1,2*; Cheikh Z1,2; Hidan Y1,2; Mchachi A1,2; Benhmidoune L1,2; Rachid R1,2; Elbelhadji M1,2

¹Faculty of Medicine and Pharmacy, Hassan II University of Casablanca, Casablanca Morocco

²Department of Ophthalmology, Hospital 20 August 1953, CHU Ibn Rochd, Morocco

*Corresponding author: Soukaina Homaide Faculty of Medicine and Pharmacy, Hassan II University of Casablanca, Casablanca Morocco. Email: Salma_moataz@hotmail.fr

Received: May 25, 2023 Accepted: June 23, 2023 Published: June 30, 2023

Summary

A 58 year-old woman with a history of diabetes mellitus and rectal Adenocarcinoma presented with acute loss of vision and pain in the left eye with hypopyon with no systemic symptoms at presentation. Diagnosis of endogenous endophthalmitis was made. Treatement was medical by topical, intravitreal and systemic antibiotics, with poor visual outcome. This case reminds ophthalmologists that endogenous endophthalmitis might be associated with underlying malignancy.

Keywords: Endogenous endophthalmitis; Diabetes mellitus; Visual acuity; Intravitreal injections; Vitrectomy

Introduction

Endogenous Endophthalmitis (EE) is a relatively rare intraocular infection caused by hematogenous spread from distant foci. It is a diagnostic challenge engaging severally both, functional and vital prognosis. Early and prompt diagnosis and treatement in early stage are crucial to prevent blindness and lethal complications

Case Report

A 58 years-old woman with a history of type 2 diabetes mellitus on oral medications, and recently diagnosed with a rectal Adenocarcinoma which was planned to be treated with chemotherapy and surgery. She presented with acute loss of vision and pain in her right eye for four days. There was no history of surgery or trauma and she was afebrile with no other systemic symptoms. Her ophthalmologic examination revealed a visual acuity at hand movement in the right eye and 10/10 in the left eye, with dense vitritis, eye fundus was not accessible (Figure 1). The left eye was normal. laboratory investigations showed: white cell count 11.11 10³/μl, neutrophils 7.41 10³/μl, lymphocytes 2.56 10³/μl, C-Reactive Protein 80mg/L. Ocular ultrasound showed vitreous membranous debris, suggestive of endophthalmitis associated with subconjunctival abscess and choroidal detachment (Figure 2), Cranial and orbital MRI showed the presence of diffuse thick enhancement of the uveal layer, with increased signal intensity within the vitreous, with 20mm/11mm subconjunctival abscess, and abnormal enhancement of optic nerve (Figure 3). The patient was treated with intravenous and intravitreal injection of antibiotics, 1mg/0.1ml vancomycin, 2.25mg/0.1ml ceftazidime, fortified antibiotics eye drops, the evolution is marked by spontaneous drainage of sub conjunctival abscess (Figure 4) and regression of pain. She was later transferred to Oncology department for the treatement and follow up of her cancer.