SHM Converge Scientific Abstract ePoster Gallery-Windows Into the Heart: Bilateral Endophthalmitis Due to Aggregatibacter Endocarditis

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This case describes a 50-year-old man with progressive bilateral eye pain, redness, floaters, and vision loss over two weeks, initially diagnosed with bilateral panuveitis. He also reported months of fatigue, night sweats, fevers, cough, weight loss, and dental caries, along with a remote history of a heart murmur. On admission, he had cervical lymphadenopathy, a holosystolic apical murmur, markedly elevated CRP, and mild leukocytosis. Because of concern for malignancy, autoimmune disease, or infection, additional workup was pursued.<br /><br />Blood cultures later grew Aggregatibacter species, a HACEK organism associated with subacute infective endocarditis. Transthoracic echocardiography revealed posterior mitral valve prolapse, a 1.2 x 0.8 cm mitral vegetation, and moderate-to-severe mitral regurgitation, confirming endocarditis. CT imaging also showed splenomegaly, liver lesions, and a mild pericardial effusion. He was treated with IV ceftriaxone for four weeks and later received high-dose prednisolone for ocular inflammation. Because of the large vegetation and significant valve dysfunction, he underwent mitral valve annuloplasty during the same hospitalization. His course was complicated by atrial fibrillation with rapid ventricular response, which was managed medically.<br /><br />The ocular diagnosis was endogenous endophthalmitis, a severe intraocular infection caused by hematogenous spread. He underwent outpatient vitrectomy, and his vision gradually improved after treatment.<br /><br />The authors emphasize that Aggregatibacter endocarditis can present insidiously, often in patients with dental disease or underlying valvular abnormalities, and cultures may grow slowly. Bilateral intraocular inflammation with systemic symptoms should prompt strong suspicion for subacute endocarditis. Early recognition, antibiotic therapy, and timely surgical consultation are critical for preventing complications and preserving vision and cardiac function.

Asset Subtitle

Alexander Poulakis

Meta Tag

Author List Alexander Poulakis, Greg E. Sanda, Jenny Y. Shen, Manasi Joshi

Category Clinical Vignettes

Concept Endogenous Endophthalmitis

Concept Subacute Infective Endocarditis

Concept Endogenous Infection

Concept Aggregatibacter

Concept Blood Culture Testing

Distinguished Non-Finalist

Presenter Organization University of Rochester Medical Center

Presenting Author Alexander Poulakis

Track Adult

Keywords

Aggregatibacter

endocarditis

panuveitis

endophthalmitis

mitral vegetation

mitral regurgitation

HACEK

blood cultures

vitrectomy

dental caries

Endogenous Endophthalmitis

Subacute Infective Endocarditis

Endogenous Infection

Aggregatibacter

Blood Culture Testing