A case of endophthalmitis presumably caused by Aggregatibacter actinomycetemcomitans Sayaka Wada 1 , Junichiro Kizaki 1 , Sohei Shimasaki 1 , Yoshihiro Wada 1 , Yuta Saito 1 , Shotaro Kosuge 1 , Hidetoshi Onda 1 1Department of Ophthalmology, Showa University School of Medicine pp.497-503
Published Date 2020/4/15
DOI https://doi.org/10.11477/mf.1410213535
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Abstract Purpose:To report a case of endophthalmitis possibly caused by Aggregatibacter actinomycetemcomitans.

Case:An 83-year-old female was referred with ocular pain and blurred vision in the left eye. The patient had received aortic valve replacement with a bioprosthetic valve for aortic stenosis 3 years before. Visual acuity was counting fingers at 10 cm in the left eye and 0.7 in the right eye. The anterior segment revealed severe anterior chamber cells and the fundus could not be determined on the left eye. A laboratory examination showed inflammation and elevated HbA1c. Later, the cultured blood specimens showed A. actinomycetemcomitans. We suspected endogenous bacterial endophthalmitis, and started treatment with intravenous meropenem and intravitreal vancomycin and ceftazidime. Echography showed development of an elevated lesion at the fundus, then pars plana vitrectomy was conducted. After removed vitreous opacity, white elevated lesion was found. Vitreous cytology and cultures remained negative. After surgery, inflammatory improved gradually. Focus of infection was not found on systemic examination. Without reactivation of inflammation, the elevated lesion became atrophic. Visual acuity raised 0.7 in the left eye at 8 months after surgery.

Conclusion:A. actinomycetemcomitans may be considered as causative bacteria of endogenous bacterial endophthalmitis. This bacteria belong to the normal bacterial flora of the oral cavity, thus periodontal disease may be searched in case of not finding the focus of endogenous endophthalmitis.

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