RAHNELLA AQUATILIS ENDOPHTHALMITIS AFTER INTRAVITREAL INJECTION IN AN IMMUNOCOMPETENT PATIENT.

Purpose: The objective of this study was to present a novel case of exogenous Rahnella aquatilis endophthalmitis following an intravitreal injection.

Methods: This was a case report.

Results: A 74-year-old man presented with acute progressive vision loss and pain in the left eye, 5 days after an intravitreal injection for diabetic macular edema. The patient was diagnosed with exogenous endophthalmitis and empirically treated with intravitreal injections of vancomycin and ceftazidime as well as topical and oral ciprofloxacin. At follow-up 2 days later, the patient was treated with preoperative povidone-iodine, followed by prompt vitrectomy with additional vancomycin and ceftazidime due to pharmacy sterile hood issues that delayed antibiotic availability. Microbiological cultures and two mass spectrometry identification tests confirmed the diagnosis of exogenous R. aquatilis endophthalmitis. Despite the presence of scattered retinal hemorrhagic infarcts involving the macula and subsequent full-thickness atrophic macular holes seen in follow-up, the patient achieved a favorable anatomical and functional outcome of best corrected visual acuity 20/80 at 1-year follow-up.

Conclusion: This case highlights the occurrence of exogenous R. aquatilis endophthalmitis following an intravitreal injection for diabetic macular edema. Prompt diagnosis and treatment produced a favorable outcome relative to other typical gram-negative Enterobacteriaceae organisms.