Endogenous Endophthalmitis and Subretinal Abscess Following Rituximab Therapy in Myasthenia Gravis: A Report of Two Cases.

Abstract

Purpose: Endogenous endophthalmitis is a serious vision-threatening condition commonly associated with immunosuppression and is invariably linked to a systemic focus. Rituximab infusion is one of the treatment options for refractory Myasthenia Gravis but can become a double-edged sword, increasing susceptibility to serious infections. This study reports the occurrence and management of Endogenous endophthalmitis in two patients after rituximab infusion given for refractory Myasthenia Gravis. Endogenous endophthalmitis post Rituximab has not been reported.

Method: A retrospective review of patients' records was done.

Results: Case 1 is a 55-year-old male, on treatment with Rituximab for refractory Myasthenia Gravis, presented with painful loss of vision in left eye for 5 days. The patient had right upper limb cellulitis, cavitary bronchopneumonia with septicaemia, 10 days prior. Left eye showed 4+ cells in the anterior chamber with fibrinous exudates and dense vitritis, confirmed on B-scan ultrasonography. Blood culture isolated Escherichia coli and methicillin-resistant Staphylococcus aureus (MRSA) sensitive to meropenem and vancomycin. The patient was administered systemic and intravitreal antibiotics along with vitrectomy. Case 2 is a 45-year-old male with a similar history and presentation to case 1, involving the right eye. Blood culture isolated Nocardia farcinia with sensitivity to amikacin and meropenem. This patient also received systemic and intravitreal antibiotics with vitrectomy. Complete resolution of the infection was noted with improvement in vision in both patients.

Conclusion: With the increasing use of Rituximab, EE incidence is likely to increase. Hence, an awareness of this uncommon complication will help in early recognition and treatment, leading to good outcomes.