PMC9330429_01
Timeline of the illness progress, pathogen identification, and treatment for the patient. VORI, voriconazole; FLU, fluconazole; GAT, gatifloxacin; AMI, amikacin; TOB, tobramycin; PEN, penicillin; SUL, sulfamethoxazole; LINE, linezolid.
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F1
The timeline is shown in Figure 1 and the complete case progress record is reported later in detail.
(A) Left eye with a massive white exudate gathered in the pupil area. (B,C,G,H) B-mode ultrasound of the left eye in different treatment stages. (D) The culture colonies of strain BCHNH01T on blood agar plate after 48 h culture. (E,F) The gram-staining and weak acid-fast staining (modified the Kinyoun's method) of strain BCHNH01T. (I) Vitreoretinal traction and suspicious retinal detachment were observed in the left eye.
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F2
Red light reflection was not observed (Figure 2A). B-mode ocular ultrasound showed an abnormal echo in the left eyeball and slight vitreous opacity (Figure 2B), suggestive of endophthalmitis caused by microbial infection. On hospital day 3, ocular B-mode ultrasound showed an abnormal echo in the left eyeball and vitreous opacity (Figure 2C). On hospital day 4, the medias at 35 C showed that some yellow, dry, and chalky colonies were present after 48 h of culturation (Figure 2D) and were identified as actinomycetes by MALDI-TOF mass spectrometry. Subsequently, gram stain and weak acid-fast stain were performed and both were positive in the isolates (Figures 2E,F). However, the ocular B-ultrasound indicated that the vitreous opacity in the left eye had not significantly changed (Figure 2G). Through the continuous application of the above anti-infection treatment for 3 weeks, the infection was effectively controlled: eye congestion was reduced; the cornea became transparent; the anterior chamber was quiet with no cell or flare being noted; and the purulent secretion disappeared (Figure 2H). On hospital day 34, vitreoretinal traction and suspicious retinal detachment were observed (Figure 2I).