First Author: H.Chien TAIWAN
Co Author(s): K. Wang K. Wuqu K. Liu
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To describe a case of Methicillin-resistant Staphylococcus aureus buckle infection complicated by endophthalmitis and presumed choroidal abscess in a patient with ulcerative colitis
Cathay General Hospital, Taipei, Taiwan
A case report
A 46-year-old male with baseline visual acuity (VA) of 20/30 in both eyes (OU), had history of high myopia and open angle glaucoma (OU). He moreover had ulcerative colitis (UC), which was well controlled with mesalamine. He suffered from rhegmatogenous retinal detachment (OD), and segmental scleral buckle with intravitreal injection of perfluoropropane was performed immediately. Postoperative examination revealed well attached retina, and the patient was discharged under stable condition. Nine days after operation, the patient presented with excessive pain, lid swelling, erythema, heat and limitations of extraocular movement (OD). VA was hand motion at 10 cm, and the active cellular reaction was 4+ in the anterior chamber. The dilated fundus examination showed vitritis with attached retina (OD). The orbital computed tomography scan revealed a significant thickening of the right eyelid and the right superior rectus and levator palpebrae superioris muscles. Complicated buckle infection with endophthalmitis was impressed. Bacterial culture yielded methicillin-resistant staphylococcus aureus (MRSA). A choroidal abscess was identified 1 week after the episode. The buckle was removed, and intravitreal and subconjunctival Vancomycin injection were performed every 2 days for 8 times. The infection subsided and complete visual recovery from hand motion to 20/30 (OD) was achieved 2 months later.
The incidence of MRSA buckle infection was significantly higher in patients with atopic dermatitis, and recent epidemiology studies documented an increased prevalence of atopic dermatitis in patients with inflammatory bowel disease. Atopic dermatitis and ulcerative colitis involve dysfunction of the mucocutaneous barrier. Chronic inflammation of the epithelium and defective innate immunity result in poor bacterial clearance. This process may increase the risk of MRSA infection in these two groups of patients. Endophthalmitis and choroidal abscess formation after SB surgery is extremely rare. Host factors including ulcerative colitis may play a role in causing the severe buckle infection of this patient.