Sir,

We describe the first case of bilateral endogenous endophthalmitis caused by Aeromonas hydrophila following bowel surgery.

Case report

A 73-year-old woman suffered prolonged paralytic ileus requiring a central venous line (CVL) for total parenteral nutrition following laparotomy to relieve intestinal obstruction. Within the first post-operative week, she had abdominal wound infection, septicaemia, and right knee septic arthritis. One week after her laparotomy, she complained of pain in the right eye with blurred vision. On ocular examination, vision was no perception of light in the right eye and 6/6 in the left. The right eye was injected with a cloudy cornea (Figure 1), IOP of 35 mmHg, 2+ cells in the anterior chamber, an amaurotic pupil, absent red reflex while the left eye appeared normal. Anterior chamber and vitreous tap with intra-vitreal antibiotics (vancomycin and gentamicin) was performed and revealed brown-green-coloured vitreous aspirate. The following morning, she complained of pain and blurred vision in the left eye (Figure 2); the vision was no perception of light, and clinical findings were identical to those found in the right eye. Therapeutic/diagnostic vitrectomy was performed in an attempt to save any useful vision but was unsuccessful. Blood samples, right knee aspirate, vitreous aspirate from both eyes, and samples from the tip of CVL all grew the Gram-negative bacillus, A. hydrophila, sensitive to ciprofloxacin and gentamicin.

Figure 1
figure 1

Injected right eye showing purulent discharge.

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Figure 2
figure 2

Left eye is relatively white with a hazy view to the anterior chamber.

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Comment

A. hydrophila is a rod-like environmental bacterium,1 which causes systemic infections1, 2 as well as conjunctivitis, keratitis, and endophthalmitis, especially post trauma.1, 2, 3, 4 It is common in Taiwan as compared to the West because of its ubiquity in the natural environment and the increasing number of susceptible hosts in Taiwan.2 A. hydrophila infections are usually seen in specific circumstances like in immunocompromised patients, especially those with malignancy or liver disease.2 A. hydrophila is highly pathogenic especially to the eye, triggers a robust inflammatory response2 with a rapid clinical course causing extensive necrosis3 with suppurative inflammation, and has a poor visual prognosis.3

This particular patient had a pond at home, and a sample from it grew A. hydrophila that may have entered her blood through the CVL. Strict aseptic technique, minimum handling, and continuous monitoring of patients with CVL can reduce the risk of infection.5