Meningitis Secondary to Pseudomonal Endophthalmitis in a Burn Patient: A Case Report and Review of the Literature
Background: To report the case of a burn patient with meningitis secondary to pseudomonal endophthalmitis that led to death.
Case Presentation: An 18-year-old female who sustained flame burns in a house fire was admitted to our burn center. She sustained burns that accounted for 68% of her total body surface area, including her face. The patient underwent multiple excision and grafting procedures. On the thirteenth post-burn day, wound cultures revealed a resistant Pseudomonas sensitive only to aminogyclosides and colistin. On the twentieth post-burn day the patient developed edema, erythema, and proptosis of the right eye. Ophthalmology was consulted and endophthalmitis was diagnosed. A lateral right canthotomy was performed. Treatment modalities including intra-vitreous antibiotic injection were discussed but not performed. Computed tomography (CT) of the head at that time showed concern for retrobulbar inflammation. There was a progressive decrease in her mental status. An additional brain CT scan showed diffuse cerebral abnormalities and edema. Clinical examination at that time demonstrated decreased cerebral activity consistent with brain death and repeat neurologic examination confirmed brain death.
Conclusion: Meningitis constitutes a rare complication of endophthalmitis and its prompt diagnosis and treatment via administration of systemic antibiotics via intravenous or intrathecal routes, with intra-vitreal antibiotics could lead to a more favorable outcome.
Endophthalmitis is a rare condition, usually occurring as a complication of intra-ocular surgery or penetrating injury. Rarely, endophthalmitis may follow metastatic spread of fungal or bacterial infection from a distant source and the majority of these patients suffer from an underlying disease. Pre-disposing factors are immunocompromise, intravenous drug abuse, and prolonged stay in intensive care.
Perez, Sergio E. and Haith, Linwood R., "Meningitis Secondary to Pseudomonal Endophthalmitis in a Burn Patient: A Case Report and Review of the Literature" (2017). Plastic Surgery Resident Research. 1.