Atypical endophthalmitis by Streptococcus pneumonia

Endogenous endophthalmitis is a serious intraocular infection resulting from hematogenous spread of microorganisms. Although Streptococcus pneumoniae is an uncommon cause, its aggressiveness can lead to severe complications.

We present the case of a 48-year-old male who presented to the emergency department with blurred vision and periorbital pain in the right eye. Examination revealed hypertensive panuveitis with vitreous hemorrhage. Broad-spectrum topical and systemic antibiotics were initiated.

Imaging studies showed signs of orbital cellulitis without venous thrombosis, and aqueous humor culture confirmed the presence of S. pneumoniae, prompting hospital admission. Despite treatment, clinical progression led to the development of an intraorbital abscess requiring evisceration, after which the patient evolved favorably, allowing for later prosthesis placement.

This case highlights the aggressiveness of pneumococcal endogenous endophthalmitis and the importance of early, multidisciplinary management.