Endogenous Endophthalmitis and Urosepsis by Escherichia coli: An Unexpected Association

Abstract

Endophthalmitis is a pathology that requires a high degree of suspicion for the diagnosis, especially in immunocompromised
patients. The rapid establishment of diagnosis and prompt initiation of treatment may avoid amaurosis. The authors
present a case of a 70-year-old woman with bilateral lung metastatic disease of a poorly differentiated large cells neuroendocrine carcinoma under chemotherapy (carboplatin and docetaxel) who was admitted five days after her last cycle
because of febrile neutropenia and urosepsis with bacteriemia by Escherichia coli. After the admission, the patient suddenly
developed acute inflammatory signs and pruritus on the right eye, which progressed exuberantly over the next 24 hours. A
computed tomography scan and a panophthalmitis were performed, with proptosis and extensive cellulitis of peri-orbital tissues was revealed. A diagnosis of endophthalmitis due to Escherichia coli hematogenous dissemination was made and
a collection of aqueous humor was performed without isolation of microbiological agents. The patient was treated with
intravitreal injection of antibiotic therapy (single dose), as well as with topical and systemic antibiotic for 21 days, showed
good evolution and no enucleation was necessary for control of infectious focus, but complete amaurosis of the affected
eye occurred.