From Gut to Globe: Endogenous Endophthalmitis as a Sentinel Sign of Polymicrobial Intra‐Abdominal Infection

TL;DR

A case of eye infection revealed a hidden serious abdominal infection, showing the importance of checking the eyes for signs of systemic illness.

Contribution

Highlights endogenous endophthalmitis as a potential sentinel sign of polymicrobial intra-abdominal infection.

Findings

Endogenous endophthalmitis was the first sign of polymicrobial bacteremia and abscesses.

Prompt ophthalmic evaluation can reveal life-threatening systemic infections.

Immunocompetent individuals can also develop severe infections presenting with ocular symptoms.

Abstract

A 42‐year‐old male presented with 1 week of left eye redness, pain, and severe vision loss. Examination revealed anterior chamber fibrin, vitritis, and vitreous opacities. B‐scan ultrasonography showed mobile hyperechoic vitreous material with an attached retina. Given his recurring fevers, a vitreous tap and injection of intravitreal antibiotics was performed, followed by systemic infectious workup. Blood cultures revealed polymicrobial bacteremia with
Klebsiella pneumoniae
and Salmonella serogroup B, secondary to colonic and hepatic abscesses confirmed by CT. Despite treatment, the eye progressed to phthisis bulbi. This case underscores the importance of ocular symptoms in identifying serious systemic infections.

Endogenous endophthalmitis may be the first and only sign of a life‐threatening systemic infection, even in immunocompetent individuals. This case highlights the importance of prompt ophthalmic evaluation and systemic workup, particularly when vision‐threatening inflammation is present in the absence of overt systemic illness.

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