Exogenous endophthalmitis caused by Enterobacter cloacae following water gun injury.

Amit Kumar Deb, Aswathi Neena, Sushmita Sana Chowdhury, Sandip Sarkar, Sangaraju Suneel, Tanmay Gokhale
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Abstract

Enterobacter is a Gram-negative anaerobic bacillus. Enterobacter-associated endophthalmitis is rare. We report Enterobacter cloacae-associated traumatic endophthalmitis following a water gun injury with no visible external entry wound. A 46-year-old man presented with features masquerading as traumatic uveitis in his left eye following injury by water stream from a toy gun. He was started on topical steroids but within 2 days of initial presentation, there was worsening of vision, presence of hypopyon in the anterior chamber and presence of vitreous exudates confirmed on ocular ultrasound B-scan. Endogenous endophthalmitis was ruled out by extensive work-up including sterile urine and blood cultures. Emergency vitrectomy was done along with lensectomy and silicone oil implantation. E. cloacae were isolated from the vitreous sample, which were sensitive to all standard antibiotics tested. Final visual acuity was 20/200. Traumatic endophthalmitis is usually preceded by a penetrating ocular injury in the form of a corneal, limbal or scleral tear with or without choroidal tissue prolapse and vitreous prolapse. A high index of suspicion is, therefore, needed for the diagnosis of endophthalmitis in the absence of corneal injury following water jet trauma to the eye.

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水枪伤后由泄殖腔肠杆菌引起的外源性眼内炎。
肠杆菌是一种革兰氏阴性厌氧芽孢杆菌。肠杆菌相关性眼内炎非常罕见。我们报告的病例是在无明显外部入口伤口的水枪伤后发生的泄殖腔肠杆菌相关性外伤性眼内炎。一名 46 岁的男子左眼被玩具枪的水流击伤后,出现了伪装成外伤性葡萄膜炎的特征。他开始接受局部类固醇治疗,但在初次就诊后的两天内,视力出现恶化,前房出现视力减退,眼部超声 B 型扫描证实有玻璃体渗出。通过包括无菌尿液和血液培养在内的大量检查排除了内源性眼内炎。紧急进行了玻璃体切除术,同时进行了晶状体切除术和硅油植入术。从玻璃体样本中分离出对所有标准抗生素都敏感的泄殖腔杆菌。最终视力为 20/200。外伤性眼内炎发生前通常会出现穿透性眼外伤,表现为角膜、角膜缘或巩膜撕裂,伴有或不伴有脉络膜组织脱垂和玻璃体脱垂。因此,在眼睛受到喷水创伤后没有角膜损伤的情况下,诊断眼内炎需要高度怀疑。
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