Endogenous panophthalmitis after colonoscopy

Excerpt

A 73-year-old woman who had been on hemodialysis for over 20 years due to autosomal dominant polycystic kidney disease underwent lower gastrointestinal endoscopy as a workup for severe constipation. Because of the anatomical difficulty attributable to her enlarged kidneys (Fig. 1a), the endoscope could not observe beyond the sigmoid colon after 2 h of investigation. On the following day, the patient suddenly developed decreased vision and pain in her left eye. An examination by ophthalmologist revealed that her left eyeball was swollen and the bulbar conjunctiva was prominently hyperemic. B-scan ultrasonography showed vitreous opacity, and left panophthalmitis was diagnosed using magnetic resonance imaging (MRI) (Fig. 1b, c). Furthermore, the patient also reported back pain, and MRI revealed pyogenic spondylitis. Although we suspected the possibility of infective endocarditis, blood culture testing was negative and transthoracic echocardiography showed no vegetation on her cardiac valves. As the causative pathogen remained unknown, the patient was treated with empirical ceftriaxone, vancomycin, and fluconazole therapy for 6 weeks. However, she did not recover vision in her left eye.

…