Abstract

SO.20.08

Listeria monocytogenes-induced endogenous endophthalmitis: case report of an 82-year-old woman

Lamparter J., Sekundo W., Eha J., Pfeiffer N., Hoffmann E. M.
Department of Ophthalmology, Johannes Gutenberg-University, Mainz

Objective: Endophthalmitis induced by Listeria monocytogenes is rare. Within the last 40 years about 25 cases have been published. All patients presented with similar symptoms, and in almost all of the cases an acute anterior uveitis with secondary glaucoma was primarily diagnosed. We report on an 82-year-old woman who was referred to our hospital because of intraocular inflammation of her right eye, decrease in visual acuity and pain. The patient had a history of rheumatoid arthritis.
Results: Slit lamp examination showed a fibrinous anterior chamber reaction with hypopyon, keratic precipitates, corneal edema and posterior synechiae. The intraocular pressure was increased to 36 mmHg, visual acuity was hand motion. An acute anterior uveitis (differential diagnosis: pseudophakic endophthalmitis) was presumed and an intensive therapy with antibiotics and corticosteroids was initiated. Listeria monocytogenes was isolated from an aqueous humor puncture. Histopathological examinations showed a putrid inflammation without any signs of malignant cells. An extraocular focus was not present. The laboratory results (hemogram, differential blood count, ESR, infection parameters etc.) were unremarkable. Neither were an X-ray of the chest, a cervical CT and different examinations (otolaryngology, neurology, gynecology, dermatology etc.) of any remark. A therapy with linezolid was initiated. Despite of intensive local and systemic therapy, the disease was progressive and visual acuity decreased to light perception. Further examinations will show long-time results.
Conclusions: Listeria monocytogenes-induced endophthalmitis is a rare disease. Typically it presents with a fibrinous anterior chamber reaction which poorly responds to corticosteroids or antibiotics. Usually patients do not show any signs of an endophthalmitis. In these cases a puncture of the anterior chamber is essential in order to prove diagnosis and to start an adequate therapy.

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