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Post-surgical endophthalmitis with secondary meningitis. About a case
Endoftalmitis postquirúrgica con meningitis secundaria. A propósito de un caso
S. Hernández Santamaría
, N. García Figuera, M. Maldonado MacCrohon, L. Jordano Luna, A. Laiseca García, M.T. Álvarez Barrio
Corresponding author
Servicio de Oftalmología, Hospital Universitario de Getafe, Getafe, Madrid, Spain
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All rights reserved" "copyrightAnyo" => "2024" "documento" => "article" "crossmark" => 0 "subdocumento" => "crp" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "Traduccion" => array:1 [ "es" => array:18 [ "pii" => "S0365669124001308" "issn" => "03656691" "doi" => "10.1016/j.oftal.2024.07.006" "estado" => "S200" "fechaPublicacion" => "2024-08-02" "aid" => "2281" "copyright" => "Sociedad Española de Oftalmología" "documento" => "simple-article" "crossmark" => 0 "subdocumento" => "crp" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "es" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Comunicación corta</span>" "titulo" => "Endoftalmitis posquirúrgica con meningitis secundaria. A propósito de un caso" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Postoperative endophthalmitis with secondary meningitis. About a case" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1295 "Ancho" => 1500 "Tamanyo" => 252162 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">En las imágenes se puede observar la evolución del paciente. En las imágenes superiores observamos la biomicroscopia del paciente a las 48<span class="elsevierStyleHsp" style=""></span>horas de la primera exploración, donde se aprecia edema corneal con hipopión de aproximadamente 3<span class="elsevierStyleHsp" style=""></span>mm, con Tyndall en cámara anterior, dificultando ver detalles debido a la turbidez. En la ecografía podemos ver abundantes ecos vítreos, que nos ayudan a confirmar el diagnóstico de endoftalmitis.</p> <p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">En las dos imágenes inferiores se aprecia la biomicroscopia del paciente en las siguientes exploraciones, con material de depósito marronáceo-blanquecino, que imposibilita la exploración del polo posterior del paciente y la visualización del iris y de la pupila. Asociaba una desepitelización de casi la totalidad corneal, de aspecto no infiltrada, que no estaba presente en exploraciones previas.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "S. Hernández Santamaría, N. García Figuera, M. Maldonado MacCrohon, L. Jordano Luna, A. Laiseca García, M.T. Álvarez Barrio" "autores" => array:6 [ 0 => array:2 [ "nombre" => "S." "apellidos" => "Hernández Santamaría" ] 1 => array:2 [ "nombre" => "N." "apellidos" => "García Figuera" ] 2 => array:2 [ "nombre" => "M." "apellidos" => "Maldonado MacCrohon" ] 3 => array:2 [ "nombre" => "L." "apellidos" => "Jordano Luna" ] 4 => array:2 [ "nombre" => "A." "apellidos" => "Laiseca García" ] 5 => array:2 [ "nombre" => "M.T." 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González Martín-Moro" "autores" => array:1 [ 0 => array:2 [ "nombre" => "J." 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The choroidal thinning (white arrow) at nasal level could be physiological and attributable to the patient’s myopia. Subfoveal hyperreflectivity resolved at two weeks (B) leaving a minimal sequel of subfoveal RPE thickening at 1.5 months (C). The outer nasal layers progressively recovered (B and C). In A-OCT 8<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>8 <span class="elsevierStyleItalic">en-face,</span> at ellipsoid layer level, hyperreflective points were observed surrounding the papilla (green arrow) at debut (D). After two weeks (E), these peripapillary hyperreflective points decreased but hyporeflective spots were observed (white arrow), which correlate with the disruption of the outer retina in autofluorescence. After 1.5 months (F), hyporeflective spots decreased and white peripapillary spots disappeared. The A-OCT 3<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>3 showed at choriocapillary level two apparent hypoperfusion spots in the debut of the disease (G), which correlate with the shadow of the subfoveal column hyperreflectivity.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "A. Moll-Udina, I. Hernanz, M. Dotti, V. Llorenç, A. Adán" "autores" => array:5 [ 0 => array:2 [ "nombre" => "A." "apellidos" => "Moll-Udina" ] 1 => array:2 [ "nombre" => "I." "apellidos" => "Hernanz" ] 2 => array:2 [ "nombre" => "M." "apellidos" => "Dotti" ] 3 => array:2 [ "nombre" => "V." "apellidos" => "Llorenç" ] 4 => array:2 [ "nombre" => "A." "apellidos" => "Adán" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0365669120303105" "doi" => "10.1016/j.oftal.2020.07.014" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365669120303105?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S217357942030219X?idApp=UINPBA00004N" "url" => "/21735794/unassign/S217357942030219X/v1_202011150602/en/main.assets" ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Short communication</span>" "titulo" => "Post-surgical endophthalmitis with secondary meningitis. About a case" "tieneTextoCompleto" => 0 "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "S. Hernández Santamaría, N. García Figuera, M. Maldonado MacCrohon, L. Jordano Luna, A. Laiseca García, M.T. Álvarez Barrio" "autores" => array:6 [ 0 => array:4 [ "nombre" => "S." "apellidos" => "Hernández Santamaría" "email" => array:1 [ 0 => "sarahernandezsantamaria@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "N." "apellidos" => "García Figuera" ] 2 => array:2 [ "nombre" => "M." "apellidos" => "Maldonado MacCrohon" ] 3 => array:2 [ "nombre" => "L." "apellidos" => "Jordano Luna" ] 4 => array:2 [ "nombre" => "A." "apellidos" => "Laiseca García" ] 5 => array:2 [ "nombre" => "M.T." "apellidos" => "Álvarez Barrio" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Oftalmología, Hospital Universitario de Getafe, Getafe, Madrid, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Endoftalmitis postquirúrgica con meningitis secundaria. A propósito de un caso" ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2024-05-09" "fechaAceptado" => "2024-07-05" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1894122" "palabras" => array:3 [ 0 => "Endophthalmitis" 1 => "<span class="elsevierStyleItalic">Proteus mirabilis</span>" 2 => "Meningitis" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1894123" "palabras" => array:3 [ 0 => "Endoftalmitis" 1 => "Proteus mirabilis" 2 => "Meningitis" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">A 61-year-old man presented hyperacute endophthalmitis due to <span class="elsevierStyleItalic">Proteus mirabilis</span> after a pars plana vitrectomy. In the first examination (24 hours after surgery), visual acuity (VA) was of hand movement, biomicroscopy showed edematous cornea, Tyndall ++++ and fibrin membrane, with vitritis and impossibility of visualizing retina details. Treatment with intravitreal injections was performed. Despite the treatment, the patient's symptoms worsened, and he began with poor general condition, fever, and leukocytosis, requiring hospitalization and intravenous treatment because of a diagnosis of secondary meningitis due to post-surgical endophthalmitis. The patient required enucleation of the affected eye without prosthesis placement.</p><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Even though post-surgical bacterial endophthalmitis is usually an infection confined to the eye, this clinical case demonstrates the possibility of the infection spreading to the rest of the body, potentially endangering the patient's life.</p></span>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Varón de 61 años, que tras vitrectomía pars plana presenta una endoftalmitis hiperaguda por <span class="elsevierStyleItalic">Proteus mirabilis</span>. En la primera exploración (24 horas de la cirugía), la agudeza visual (AV) era movimiento de manos, en la biomicroscopia presenta córnea edematosa, Tyndall ++++ y membrana de fibrina, con vitritis e imposibilidad de visualizar detalles en el fondo de ojo (FO). Se realizó tratamiento con inyecciones intravítreas. A pesar del tratamiento, la clínica empeora, y comienza con mal estado general, fiebre y leucocitosis, precisando ingreso en la planta de medicina interna y tratamiento intravenoso por diagnóstico de meningitis secundaria a endoftalmitis postquirúrgica. Para la resolución completa del cuadro, precisó enucleación del ojo afecto sin prótesis.</p><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Pese a que la endoftalmitis bacteriana postquirúrgica suele ser una infección confinada al ojo, este caso clínico demuestra la posibilidad de que la infección se disemine sistémicamente y al sistema nervioso central, pudiendo peligrar la vida del paciente.</p></span>" ] ] ] "idiomaDefecto" => "en" "url" => "/21735794/unassign/S2173579424001683/v1_202410170446/en/main.assets" "Apartado" => null "PDF" => "https://static.elsevier.es/multimedia/21735794/unassign/S2173579424001683/v1_202410170446/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173579424001683?idApp=UINPBA00004N" ]
