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1 J Cardiol 2002 Mar; 39 3 : Infective Endocarditis Complicating Bilateral Bacterial Ophthalmitis: A Case Report Takeshi Takashi Seishi Takayoshi Noriko Mari Yoriko Kenichi Toshiji SENO, MD NISHIUE, MD NAKAMURA, MD FUJISAKI, MD MATSUMOTO, MD TOKIOKA, MD NAKATA, MD MANABE, MD IWASAKA, MD, FJCC Abstract A 53-year-old female suddenly went blind in her left eye on 3 June, She was admitted to the Department of Ophthalmology of our hospital under the diagnosis of endophthalmitis. Her left eye was enucleated, and Streptococcus agalactiae was found in the vitreous fluid. After left ophthalmectomy, inflammation recurred after cessation of antibiotic administration. Echocardiography demonstrated a vegetation of the posterior mitral valve. The diagnosis was infective endocarditis. She was transferred to the Department of Internal Medicine. Mitral regurgitation deteriorated during the course of medical therapy, but she was discharged on 13 September, 2000 because inflammation had improved remarkably and the vegetation had disappeared after administration of penicillin G, panipenem, cefotaxime and clindamycin. We suspected that embolism of the ophthalmic artery was the cause of the sudden blindness in her left eye. Infective endocarditis with bacterial endophthalmitis is very rare in Japan. J Cardiol 2002 Mar; 39 3 : Key Words Infectious disease bacterial ophthalmitis Endocarditis Mitral regurgitation Complications 1 53 : : 50 : : : Internal Medicine II, Kansai Medical University, Osaka Address for correspondence : NISHIUE T, MD, Internal Medicine II, Kansai Medical University, Fumizono-cho 10 15, Moriguchi, Osaka Manuscript received August 21, 2001; revised November 19, 2001; accepted November 19,
2 172 Fig. 1 Photographs showing bilateral ophthalmitis Left: Hypopion is shown in the right eye. Right : Severe hyperemia of the conjunctiva and opacity of the vitreous body are shown in the left eye. 6 5 Fig B Streptcoccus agalactiae : S.agalactiae : 157cm 50 kg 37.1 C 109/70mmHg 98/min 3 Levine / 5 : 8,700/ l C 16.8 mg/dl C B 345mg/dl A 1C 5.9% : 77.6 mmhg32.2 mmhg X : 50% : lateral scallop mm Lateral scallop 42mm 49 mm 33 mm Fig. 2 computed tomography : CT : Fig. 3 : S.agalactiae : 6 21 G 1, U/day g/day mm C 5.9 mg/dl g/day mm C 2.3mg/dl C 1,200 mg/day C mg/dl 8 9 J Cardiol 2002 Mar; 39 3 :
3 眼内炎を合併した感染性心内膜炎 Fig. 2 Transthoracic echocardiograms showing prolapse of the posterior mitral valve leaflet lateral scallop with vegetation and moderate mitral valve regurgitation A : Parasternal long-axis view. B : Parasternal short-axis view at the mitral valve level. C : Parasternal long-axis view color Doppler image. D : Parasternal short-axis view at the mitral valve level color Doppler image. RV=right ventricle ; LV=left ventricle ; LA=left atrium. J Cardiol 2002 Mar; 39 3 :
4 174 Fig. 3 Computed tomography scans with contrast medium showing a wedge-shaped area without enhancement arrows in the spleen left and right kidney right mm mm X 9 13 Fig. 4 CT S.agalactiae S.agalactiae % 25% % 11% 5 Klebsiella pneumoniae 77.4% 5 40% 6 32% 25% 6 J Cardiol 2002 Mar; 39 3 :
5 175 Fig. 4 Clinical course and treatment After left ophthalmectomy, inflammatory findings increased after cessation of antibiotic therapy. Mitral regurgitation became worse during the course of medical therapy, but inflammatory findings became negative and the vegetation disappeared after administration of antibiotics. Since left atrial dimension and left ventricular end-systolic dimension had not enlarged significantly and fractional shortening remained within the normal range, she was discharged on 13 September, WBC white blood cell ; CRP C-reactive protein ; MR mitral valve regurgitation ; LAD left atrial dimension ; LVDs left ventricular end-systolic dimension ; FS fractional shortening ; PAPM panipenem; PCG penicillin G ; CTX cefotaxime ; CLDM clindamycin B Streptococcus agalactiae G 9 13 J Cardiol 2002 Mar; 39 3 : J Cardiol 2002 Mar; 39 3 :
6 176 1 : Streptococcus agalactiae ; 63: : 1993 ; 20 : : : 1991; 95 : Matsuda H, Okada M, Tsukahara Y, Yamamoto M : Simultaneous surgery for infective endocarditis and endophthalmitis. J Cardiovasc Surg Torino 1999 ; 40: Wong JS, Chan TK, Lee HM, Chee SP : Endogenous bacterial endophthalmitis : An east Asian experience and a reappraisal of a severe ocular affliction. Ophthalmology 2000; 107: Pringle SD, McCartney AC, Marshall DA, Cobbe SM : Infective endocarditis caused by Streptococcus agalactiae. Int J Cardiol 1989; 24: J Cardiol 2002 Mar; 39 3 :
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