A Rare Case of Acute Post-cataract Surgery Endophthalmitis Associated With Achromobacter xylosoxidans

TL;DR

A rare case of eye infection after cataract surgery caused by Achromobacter xylosoxidans was successfully treated with multiple surgeries and antibiotics.

Contribution

This paper reports a rare clinical case of Achromobacter xylosoxidans causing post-cataract endophthalmitis and highlights effective treatment strategies.

Findings

Achromobacter xylosoxidans can cause severe post-cataract endophthalmitis.

Prompt surgical intervention improved the patient's vision despite initial antibiotic resistance.

Complete removal of the intraocular lens and capsulectomy led to favorable outcomes.

Abstract

Achromobacter xylosoxidans is rarely reported as a causative agent of post-cataract surgery endophthalmitis. Here, we present a case where timely surgical intervention preserved the patient's vision. A 68-year-old man presented with clinical signs of endophthalmitis in his right eye three days after uneventful cataract surgery. He was initially treated with intravitreal, topical, and systemic antibiotics.

After starting intravitreal, topical, and systemic antibiotics, his condition deteriorated on the second day of treatment. A prompt pars plana vitrectomy (PPV) with the removal of the posterior chamber intraocular lens (PCIOL) was performed. Culture from the intravitreal tapping yielded A. xylosoxidans, which was sensitive to ceftazidime and piperacillin. His condition was better post-PPV, and the infection was under control until day 10 post-first PPV. There was a recrudescence of infection with a recurrence of hypopyon and loculations detected on B-scan ultrasound. A second PPV with the complete removal of the lens capsule was performed. One month later, his right eye was quiet without inflammation, with a best-corrected vision of 20/30.

A. xylosoxidans is a rare but serious pathogen of endophthalmitis that often necessitates multiple surgical interventions. Although it may not initially respond to intravitreal injections and vitrectomy, appropriate treatment, such as the removal of the intraocular lens and capsulectomy, can still result in favorable visual outcomes.

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