PMC7358084_01
Clinical images of Achromobacter xylosoxidans endophthalmitis. (A) Ultrasonography performed when the patient presented with anterior chamber hypopyon revealed preretinal membranes suggestive of endophthalmitis which prompted pars plana vitrectomy. (B) Post-vitrectomy ultrasonography revealed improvement in vitreous membranes and vitiritis but demonstrated a retinal detachment. The retinal detachment was repaired with a second vitrectomy with the use of silicone oil tamponade. (C) Four months following initial vitrectomy for endophthalmitis, the patient presented with an opacified corneal graft and anterior chamber membranes suggestive of recurrent infection. The patient underwent anterior chamber washout with empiric intracameral injection of vancomycin (1mg/0.1cc) and amphotericin B (5mcg/0.1cc). Anterior chamber fluid samples submitted to microbiology grew Achromobacter xylosoxidans. (D) Following the anterior chamber washout and intracameral antimicrobial injections, the corneal haze and anterior chamber membranes improved, but there was recurrence of a corneal endoplaque indicating persistent infection.
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His ocular ultrasound (Figure 1A) and examination were consistent with endophthalmitis. His postoperative course was complicated by retinal detachment, which was detected on ultrasound three weeks postoperatively (Figure 1B), so he underwent repeated vitrectomy with injection of silicone oil (SO). Six weeks later and a total of four months after his initial vitrectomy for endophthalmitis, the patient developed pain and was observed to have inflammatory membranes in the anterior chamber (Figure 1C), which prompted anterior chamber washout and intracameral injection of vancomycin (1mg/0.1cc) and Amphotericin B (5mcg/0.1cc). His anterior chamber paracentesis sample grew Achromobacter xylosoxidans, and despite targeted topical therapy, the endothelial plaque returned (Figure 1D) and the patient was referred for evaluation at a tertiary referral center.
Clinical images of chronic, recurrent Achromobacter xylosoxidans endophthalmitis. (A) At the time of presentation to a tertiary center, slit lamp photography demonstrated minimal conjunctival injection and an opacified corneal graft with an endoplaque, which is highlighted with a narrowed beam (B). (C) Five months after repeat penetrating keratoplasty, removal of intraocular lens and lens capsule, and intravitreal injection of antibiotics, the patient's corneal graft remained clear. (D) The patient's retina remained attached under silicone oil with a focus of fibrovascular proliferation at the inferotemporal margin of the optic disc.
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His anterior segment exam revealed an opacified corneal graft with paracentral thinning, no corneal epithelial defects, a retrocorneal plaque, and no view into the anterior chamber (Figure 2A and B). His graft has remained clear and there was no evidence of infection or intraocular inflammation (Figure 2C and D).