Salmonella-associated endophthalmitis in healthy infants: Two case reports and a review of the literature

Purpose

To report two cases of endophthalmitis caused by Salmonella species in healthy male infants.

Background

Endogenous endophthalmitis is a rare but severe intraocular infection, often associated with systemic risk factors such as diabetes mellitus, malignancies, or immunosuppression. However, Salmonella species as a causative agent in immunocompetent neonates remains exceedingly rare, with only a handful of cases documented.

Observations

We present two cases of previously healthy male infants diagnosed with Salmonella-associated endogenous endophthalmitis (SAEE). The first patient, a 2-month-old male, presented with fever, left upper eyelid swelling, and decreased activity, and was found to have intraocular cultures that confirmed Salmonella species. Despite aggressive intravenous and intravitreal antibiotic therapy, the patient developed progressive intraocular inflammation, necessitating left eye evisceration.

The second patient, a 5-month-old male, presented with fever and right eye inflammation. Examination revealed a hypopyon, hyphema, and dense vitritis in the right eye. Blood and vitreous cultures confirmed Salmonella infection, and magnetic resonance imaging (MRI) showed right peribulbar abscess formation. Due to poor response to medical therapy, right eye enucleation was performed.

Conclusion and importance

Salmonella-associated endogenous endophthalmitis is a rare but aggressive intraocular infection that can rapidly progress to irreversible visual loss, even in immunocompetent neonates. Early recognition, aggressive antimicrobial therapy, and timely surgical intervention remain critical to optimizing outcomes.