Endogenous Serratia marcescens panophthalmitis

A case series

Mark P. Breazzano, Gowtham Jonna, Niraj Nathan, Hilary H. Nickols, Anita Agarwal

Research output: Contribution to journalArticle

Abstract

Purpose: – Two rare and unusual cases of endogenous panophthalmitis from Serratia marcescens are presented with mechanisms for infection explored. Observations – The first patient had history of intravenous drug use (IVDU) without any medical implants. The second patient, in addition to IVDU, had a history of end-stage renal disease with upper extremity arteriovenous fistula graft infection from Serratia marcescens confirmed by wound culture. One patient had a history of licking the needles prior to IV drug injection. Clinical exam in both cases revealed light perception vision, relative afferent pupillary defect, periorbital edema with limited extraocular motility, and hypopyon in the affected eyes. Cultures from the anterior chamber aspirate were positive for Serratia marcescens in the first case and demonstrated Gram-negative rods in the second. Attempted vitreous aspiration was unsuccessful at obtaining specimens. Computed tomography demonstrated orbital fat stranding without abscess, and histopathology showed intense neutrophilic infiltration in all layers of enucleated specimen in case one. Conclusions and Importance: Needle licking may be an underappreciated mechanism for endogenous endophthalmitis in intravenous drug users. This report includes the first case in the literature, to authors’ knowledge, of non-nosocomial endogenous Serratia marcescens panophthalmitis with orbital cellulitis. The second case illustrates a rare consequence of the rise in arteriovenous fistula placement and dialysis across the United States, which may predispose to future cases of endogenous Serratia marcescens endophthalmitis. This series supports previous observations of Serratia marcescens endogenous endophthalmitis exhibiting a generally poor visual prognosis.

Original languageEnglish (US)
Article number100531
JournalAmerican Journal of Ophthalmology Case Reports
Volume16
DOIs
StatePublished - Dec 1 2019

Fingerprint

Panophthalmitis
Serratia marcescens
Endophthalmitis
Arteriovenous Fistula
Needles
Orbital Cellulitis
Pupil Disorders
Pharmaceutical Preparations
Anterior Chamber
Drug Users
Infection
Upper Extremity
Abscess
Chronic Kidney Failure
Dialysis
Edema
Fats
Tomography
Transplants
Light

Keywords

  • Arteriovenous fistula
  • Dialysis
  • Endogenous endophthalmitis
  • Intravenous drug use
  • Panophthalmitis
  • Serratia marcescens

ASJC Scopus subject areas

  • Ophthalmology

Cite this

Endogenous Serratia marcescens panophthalmitis : A case series. / Breazzano, Mark P.; Jonna, Gowtham; Nathan, Niraj; Nickols, Hilary H.; Agarwal, Anita.

In: American Journal of Ophthalmology Case Reports, Vol. 16, 100531, 01.12.2019.

Research output: Contribution to journalArticle

Breazzano, Mark P. ; Jonna, Gowtham ; Nathan, Niraj ; Nickols, Hilary H. ; Agarwal, Anita. / Endogenous Serratia marcescens panophthalmitis : A case series. In: American Journal of Ophthalmology Case Reports. 2019 ; Vol. 16.
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