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Mayo Clin Proc. 2005;80:74 © 2005 Mayo Foundation for Medical Education and Research

MEDICAL IMAGES

Group B Streptococcus Endocarditis with Endophtalmitis

A 42-year-old man presented with fever and altered mental status, and group B streptococcus (GBS) infective endocarditis was diagnosed. Examination of the right eye showed injection of the conjunctiva with corneal clouding and no light reflex. The patient had endophthalmitis due to manifestation of septic embolus and underwent enucleation of the right eye. The specimen had pus in both anterior and posterior chambers with multiple foci of abscess formation in the sclera and cornea. The patient underwent aortic valve replacement. Examination of the defective valve showed multiple foci of gram-positive cocci with vegetations and fibrin deposition on the leaflet.

Group B streptococcus is an uncommon cause of infective endocarditis. Chronic conditions such as alcoholism, liver cirrhosis, diabetes mellitus, human immunodeficiency virus infection, and cancer are considered risk factors for GBS infective endocarditis. Group B streptococcus infective endocarditis is aggressive, and cardiac surgery is required when heart failure or embolic phenomena occur.1 Endophthalmitis is a rare manifestation of septic emboli due to infective endocarditis. In a study of endogenous endophthalmitis, GBS was found in 7% of cases, with the main source of infection being infective endocarditis.² Because endophthalmitis causes rapid and widespread destruction of the choroid and retina, visual prognosis is grave despite treatment with intravenous antibiotics.³ Extensive involvement of the posterior chamber of the eye may necessitate intravitreal antibiotics or enucleation of the eye.⁴

REFERENCES

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2. Farber BP, Weinbaum DL, Dummer JS.  Metastatic bacterial endophthalmitis. Arch Intern Med. 1985;145:62-64.
   
   
3. Lee SY, Chee SP.  Group B Streptococcus endogenous endophthalmitis: case reports and review of the literature. Ophthalmology. 2002;109:1879-1886.
   
   
4. O’Brart DP, Eykyn SJ.  Septicaemic infection with group B streptococci presenting with endophthlamitis in adults. Eye. 1992;6(pt 4):396-399.