Case Report
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Nov 26, 2019; 7(22): 3904-3911
Published online Nov 26, 2019. doi: 10.12998/wjcc.v7.i22.3904
Exogenous endophthalmitis caused by Enterococcus casseliflavus: A case report
Qing-Dong Bao, Tai-Xiang Liu, Meng Xie, Xiang Tian
Qing-Dong Bao, Tai-Xiang Liu, Meng Xie, Xiang Tian, Department of Ophthalmology, Affiliated Hospital of Zunyi Medical University, Zunyi 563000, Guizhou Province, China
Author contributions: Liu TX designed the study; Liu TX, Tian X and Bao QD contributed surgical treatment and collection of follow-up data; Bao QD wrote the paper; Xie M revised the manuscript; All authors read and approved the final manuscript.
Supported by National Natural Science Foundation of China, No. 81660169.
Informed consent statement: Consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Tai-Xiang Liu, MD, Professor, Department of Ophthalmology, Affiliated Hospital of Zunyi Medical University, 149 Dalian Road, Huichuan District, Zunyi 563000, Guizhou Province, China. 0852.ltx@163.com
Telephone: +86-18886205044
Received: August 19, 2019
Peer-review started: August 19, 2019
First decision: September 23, 2019
Revised: October 13, 2019
Accepted: October 30, 2019
Article in press: October 30, 2019
Published online: November 26, 2019
Abstract
BACKGROUND

Endophthalmitis caused by Enterococci is rare, and cases involving vancomycin-resistant enterococci are even rarer. We report the first case of Enterococcus casseliflavus endophthalmitis associated with injury caused by a pig. We also review reported cases of exogenous endophthalmitis caused by Enterococcus casseliflavus and discuss the clinical management and prognosis of this disease.

CASE SUMMARY

A 43-year-old man with no previous visual problems complained of endophthalmitis in his left eye following injury caused by a pig. Visual acuity was light perception and B-ultrasonography revealed vitreous opacities with retinal detachment. He was treated with intravitreal vancomycin and ceftazidime after refusing vitrectomy. However, the vitreous opacities and retinal detachment deteriorated and he underwent vitrectomy 5 d post-injury. Intraoperatively, advanced rhegmatogenous and tractional retinal detachment with proliferative vitreoretinopathy were observed. On postoperative day 5, vitreous cultures grew Gram-positive cocci identified as Enterococcus casseliflavus. A 2-wk course of intravenous ampicillin and dexamethasone was commenced. On postoperative day 14, visual acuity improved to hand movement. At 6 mo post-injury, visual acuity improved to 20/667, but optic atrophy was present.

CONCLUSION

Systemic administration of linezolid in the treatment of Enterococcus casseliflavus endophthalmitis can improve visual acuity. However, intravitreal amikacin should be considered despite concerns of toxicity when oral linezolid fails to prompt improvement.

Keywords: Vancomycin-resistant, Enterococci, Enterococcus casseliflavus endophthalmitis, Treatment, Case report

Core tip: The emergence of vancomycin-resistant enterococci endophthalmitis is of grave concern. To date, four cases of Enterococcus casseliflavus endophthalmitis have been reported in the literature. We describe the first case of Enterococcus casseliflavus endophthalmitis associated with injury caused by a pig and the treatment regimen. In addition, we review the literature and discuss the clinical management and prognosis of this disease.