Case Presentation: This is the case of a 69 year old woman with a history of diabetes and peripheral arterial disease who presented with eye pain for two days prior to admission. Of note, she was recently admitted to the hospital for a left foot infection requiring amputation; her hospital course was complicated by MRSA bacteremia for which she was being treated. Several days after discharge, the patient developed right eye pain and vision changes, along with worsening encephalopathy. On arrival to the hospital, she was evaluated by ophthalmology, and found to have Pseudomonas aeruginosa growing from her vitreous humor. Blood cultures also grew Pseudomonas, and presumed to be likely related to her prior foot infection. She was given an intravitreous injection of ceftazidime by ophthalmology, followed by intravenous meropenem for a total six week course. She was also continued on antibiotic eyedrops. Her mental status improved, however she had significantly diminished vision in her right eye that was permanent.
Discussion: Pseudomonas is a pathogen that is known to cause potential eye infections including endophthalmitis, however it is typically introduced directly into the vitreous humor via trauma or surgery, with hematogenous spread exceedingly rare. Since our patient did not have any recent eye surgery or manipulation, it is presumed that she developed bacteremia from her prior foot infection that spread to her eye, unfortunately leading to significant vision loss. This infection has a rapid onset, with patients complaining of symptoms of severe eye pain and vision changes. Poor visual outcomes are common, with more than half of patients developing evisceration or enucleation of the affected eye despite treatment. Treatment involves intravitreal antibiotics.
Conclusions: We present a rare case of a patient with hematogenous spread of P. aerugenosa to the vitreous humor. Early diagnosis is vital for the treatment of Pseudomonas endophthalmitis given the fulminant nature of the disease and the high risk for permanent vision loss, as seen in our patient.