# Endophthalmitis With Subretinal Abscesses Presenting as Charles Bonnet Syndrome in a Patient With Methicillin-Resistant Staphylococcus aureus (MRSA) Bacteremia: A Case Report and Discussion of the Literature

## TL;DR

A 73-year-old man with MRSA bacteremia developed eye infections and hallucinations, highlighting the need for early ophthalmologic care in similar cases.

## Contribution

This case report emphasizes the under-recognized link between MRSA bacteremia and subretinal abscesses presenting as Charles Bonnet syndrome.

## Key findings

- The patient developed bilateral endophthalmitis and subretinal abscesses linked to MRSA bacteremia.
- Visual hallucinations were attributed to Charles Bonnet syndrome in the context of declining vision.
- Early ophthalmologic evaluation is critical in patients with MRSA bacteremia and vision changes.

## Abstract

We present the case of a 73-year-old male with recurrent necrotizing fasciitis and methicillin-resistant Staphylococcus aureus (MRSA) bacteremia who developed visual hallucinations and altered mental status on post operative day one after undergoing right knee prosthetic joint infection washout. His visual acuity, which was self reported as previously “very good” decreased to hand motion in the right eye (OD) and 20/400-1 in the left eye (OS), and he described new visual hallucinations. Differentials included post operative delirium, stroke, and ocular infiltration of his bacteremia. He was evaluated by infectious disease, orthopedic surgery, neurology, and ophthalmology specialties, and was found to have bilateral endophthalmitis, Charles Bonnet syndrome, and bilateral subretinal abscesses. The patient was treated with intravenous (IV) antibiotics and surgical removal of his infected knee hardware; however, he and his family members ultimately made the decision to withdraw goal-directed care. We present this case to emphasize the importance of ophthalmologic evaluation and early intervention in patients with MRSA bacteremia and alterations in vision or mentation.