Sterile endogenous panophthalmitis with uncontrolled diabetes
A female patient with type 2 diabetes in her 50s presented to casualty with a 1-day history of red, painful right eye. Visual acuity (VA) bilaterally was 6/12, but a right anterior uveitis was noted, with hazy fundal view. She was discharged on topical steroid and mydriatic drops with a 2-day follow...
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| Veröffentlicht in: | BMJ case reports 2022-10, Vol.15 (10), p.e252875 |
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| creator | Azzopardi, Matthew Ng, Benjamin Chong, Yu Jeat |
| description | A female patient with type 2 diabetes in her 50s presented to casualty with a 1-day history of red, painful right eye. Visual acuity (VA) bilaterally was 6/12, but a right anterior uveitis was noted, with hazy fundal view. She was discharged on topical steroid and mydriatic drops with a 2-day follow-up. VA remained unchanged, but she developed right proptosis, restricted eye movements, lid swelling, relative afferent pupillary defect and an intraocular pressure (IOP) of 39 mm Hg. She was admitted and treated with intravenous and intravitreal antibiotics, intravenous antifungals and IOP-lowering drugs. Blood tests showed raised inflammatory markers and an HbA1c of 127 mmol/mol. Over her admission, right eye vision deteriorated to no light perception. A B-scan ultrasound revealed panophthalmitis and a retinal abscess. All investigations looking for a source were negative. Inflammatory markers settled, but despite aggressive treatment, the panophthalmitis did not improve. She was discharged with a follow-up to consider enucleation. |
| doi_str_mv | 10.1136/bcr-2022-252875 |
| format | Article |
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Visual acuity (VA) bilaterally was 6/12, but a right anterior uveitis was noted, with hazy fundal view. She was discharged on topical steroid and mydriatic drops with a 2-day follow-up. VA remained unchanged, but she developed right proptosis, restricted eye movements, lid swelling, relative afferent pupillary defect and an intraocular pressure (IOP) of 39 mm Hg. She was admitted and treated with intravenous and intravitreal antibiotics, intravenous antifungals and IOP-lowering drugs. Blood tests showed raised inflammatory markers and an HbA1c of 127 mmol/mol. Over her admission, right eye vision deteriorated to no light perception. A B-scan ultrasound revealed panophthalmitis and a retinal abscess. All investigations looking for a source were negative. Inflammatory markers settled, but despite aggressive treatment, the panophthalmitis did not improve. She was discharged with a follow-up to consider enucleation.</description><identifier>ISSN: 1757-790X</identifier><identifier>EISSN: 1757-790X</identifier><identifier>DOI: 10.1136/bcr-2022-252875</identifier><identifier>PMID: 36307143</identifier><language>eng</language><publisher>England: BMJ Publishing Group LTD</publisher><subject>Abscesses ; Anti-Bacterial Agents - therapeutic use ; Antibiotics ; Antibodies ; Antifungal agents ; Case reports ; Case Reports: Rare disease ; Cellulitis ; Diabetes ; Diabetes Mellitus, Type 2 - complications ; Diabetes Mellitus, Type 2 - drug therapy ; Endocarditis ; Eye ; Female ; Humans ; Hypertension ; Infections ; Inflammation ; Insulin ; Medical imaging ; Panophthalmitis - diagnosis ; Panophthalmitis - drug therapy ; Substance abuse treatment ; Syphilis ; Ultrasonic imaging ; Visual Acuity</subject><ispartof>BMJ case reports, 2022-10, Vol.15 (10), p.e252875</ispartof><rights>BMJ Publishing Group Limited 2022. No commercial re-use. See rights and permissions. Published by BMJ.</rights><rights>2022 BMJ Publishing Group Limited 2022. No commercial re-use. See rights and permissions. Published by BMJ.</rights><rights>BMJ Publishing Group Limited 2022. No commercial re-use. See rights and permissions. Published by BMJ. 2022</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c334t-1fc1feae9a977f5a61e18ca25f8940253fc9dc1ad644033407c2d65e5f385f4f3</cites><orcidid>0000-0003-4296-2948 ; 0000-0002-8571-2503</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC9621171/pdf/$$EPDF$$P50$$Gpubmedcentral$$H</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC9621171/$$EHTML$$P50$$Gpubmedcentral$$H</linktohtml><link.rule.ids>230,314,727,780,784,885,27923,27924,53790,53792</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/36307143$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Azzopardi, Matthew</creatorcontrib><creatorcontrib>Ng, Benjamin</creatorcontrib><creatorcontrib>Chong, Yu Jeat</creatorcontrib><title>Sterile endogenous panophthalmitis with uncontrolled diabetes</title><title>BMJ case reports</title><addtitle>BMJ Case Rep</addtitle><description>A female patient with type 2 diabetes in her 50s presented to casualty with a 1-day history of red, painful right eye. Visual acuity (VA) bilaterally was 6/12, but a right anterior uveitis was noted, with hazy fundal view. She was discharged on topical steroid and mydriatic drops with a 2-day follow-up. VA remained unchanged, but she developed right proptosis, restricted eye movements, lid swelling, relative afferent pupillary defect and an intraocular pressure (IOP) of 39 mm Hg. She was admitted and treated with intravenous and intravitreal antibiotics, intravenous antifungals and IOP-lowering drugs. Blood tests showed raised inflammatory markers and an HbA1c of 127 mmol/mol. Over her admission, right eye vision deteriorated to no light perception. A B-scan ultrasound revealed panophthalmitis and a retinal abscess. All investigations looking for a source were negative. Inflammatory markers settled, but despite aggressive treatment, the panophthalmitis did not improve. She was discharged with a follow-up to consider enucleation.</description><subject>Abscesses</subject><subject>Anti-Bacterial Agents - therapeutic use</subject><subject>Antibiotics</subject><subject>Antibodies</subject><subject>Antifungal agents</subject><subject>Case reports</subject><subject>Case Reports: Rare disease</subject><subject>Cellulitis</subject><subject>Diabetes</subject><subject>Diabetes Mellitus, Type 2 - complications</subject><subject>Diabetes Mellitus, Type 2 - drug therapy</subject><subject>Endocarditis</subject><subject>Eye</subject><subject>Female</subject><subject>Humans</subject><subject>Hypertension</subject><subject>Infections</subject><subject>Inflammation</subject><subject>Insulin</subject><subject>Medical imaging</subject><subject>Panophthalmitis - diagnosis</subject><subject>Panophthalmitis - drug therapy</subject><subject>Substance abuse treatment</subject><subject>Syphilis</subject><subject>Ultrasonic imaging</subject><subject>Visual Acuity</subject><issn>1757-790X</issn><issn>1757-790X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNpdkUtLAzEUhYMoVmrX7mTAjZuxeUwmMwsFKb6g4EIFdyHN3HRSppOazCj-e1NaS_VuciHfPZzDQeiM4CtCWD6eaZ9STGlKOS0EP0AnRHCRihK_H-7tAzQKYYHjMJIVGTtGA5YzLEjGTtD1SwfeNpBAW7k5tK4PyUq1blV3tWqWtrMh-bJdnfStdm3nXdNAlVRWzaCDcIqOjGoCjLbvEL3d371OHtPp88PT5HaaasayLiVGEwMKSlUKYbjKCZBCK8pNUWaYcmZ0WWmiqjzLcLzAQtMq58ANK7jJDBuim43uqp8todIQnahGrrxdKv8tnbLy709razl3n7LMKSGCRIHLrYB3Hz2ETi5t0NA0qoUYWVLBMKME5zyiF__Qhet9G-NFipZlvjYcqfGG0t6F4MHszBAs1-3I2I5ctyM37cSL8_0MO_63C_YDC-KMGQ</recordid><startdate>20221028</startdate><enddate>20221028</enddate><creator>Azzopardi, Matthew</creator><creator>Ng, Benjamin</creator><creator>Chong, Yu Jeat</creator><general>BMJ Publishing Group LTD</general><general>BMJ Publishing Group</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>BTHHO</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0003-4296-2948</orcidid><orcidid>https://orcid.org/0000-0002-8571-2503</orcidid></search><sort><creationdate>20221028</creationdate><title>Sterile endogenous panophthalmitis with uncontrolled diabetes</title><author>Azzopardi, Matthew ; 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Visual acuity (VA) bilaterally was 6/12, but a right anterior uveitis was noted, with hazy fundal view. She was discharged on topical steroid and mydriatic drops with a 2-day follow-up. VA remained unchanged, but she developed right proptosis, restricted eye movements, lid swelling, relative afferent pupillary defect and an intraocular pressure (IOP) of 39 mm Hg. She was admitted and treated with intravenous and intravitreal antibiotics, intravenous antifungals and IOP-lowering drugs. Blood tests showed raised inflammatory markers and an HbA1c of 127 mmol/mol. Over her admission, right eye vision deteriorated to no light perception. A B-scan ultrasound revealed panophthalmitis and a retinal abscess. All investigations looking for a source were negative. Inflammatory markers settled, but despite aggressive treatment, the panophthalmitis did not improve. She was discharged with a follow-up to consider enucleation.</abstract><cop>England</cop><pub>BMJ Publishing Group LTD</pub><pmid>36307143</pmid><doi>10.1136/bcr-2022-252875</doi><orcidid>https://orcid.org/0000-0003-4296-2948</orcidid><orcidid>https://orcid.org/0000-0002-8571-2503</orcidid></addata></record> |
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| subjects | Abscesses Anti-Bacterial Agents - therapeutic use Antibiotics Antibodies Antifungal agents Case reports Case Reports: Rare disease Cellulitis Diabetes Diabetes Mellitus, Type 2 - complications Diabetes Mellitus, Type 2 - drug therapy Endocarditis Eye Female Humans Hypertension Infections Inflammation Insulin Medical imaging Panophthalmitis - diagnosis Panophthalmitis - drug therapy Substance abuse treatment Syphilis Ultrasonic imaging Visual Acuity |
| title | Sterile endogenous panophthalmitis with uncontrolled diabetes |
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