Endogenous Endophthalmitis and Embolic Retinopathy Associated with Infective Endocarditis Caused by Staphylococcus aureus

Purpose: We report a rare case of bilateral endogenous endophthalmitis and unilateral embolic retinopathy from methicillin-sensitive Staphylococcus aureus (MSSA) infective endocarditis in a Korean patient with systemic lupus erythematosus (SLE). Case summary: A 22-year-old woman was transferred to a tertiary university hospital for fever, dyspnea, and drowsiness for one day. An echocardiogram revealed mitral regurgitation and mitral valve vegetation, and MSSA was isolated from blood samples. Based on these findings, she was diagnosed with MSSA infective endocarditis. Multifocal discoid chorioretinitis with vitritis was noted in both eyes. Intravitreal injections of vancomycin (1 mg/0.1 mL) and ceftazidime (2 mg/0.1 mL) were administered. Optical coherence tomography (OCT) revealed hyperreflective vegetation in the suprachoroidal area, causing pigment epithelial detachment, which spread to the sensory retina. Embolic retinopathy was found in the right eye. Magnetic resonance imaging of the brain showed multifocal subacute infarctions caused by septic emboli. These findings led to a second diagnosis of SLE and associated nephritis, for which she underwent mitral valve replacement surgery. Her final visual acuity was 20/32 in the right eye and 20/20 in the left eye. There were chorioretinal atrophic scars in both eyes and an area of nonperfused vascular sheathing of the distal retinal arteries in the right eye. OCT showed areas of pigment epithelial atrophy and outer retinal defects in the areas with previous chorioretinitis. Conclusions: Physicians should consider endogenous endophthalmitis and embolic retinopathy in patients with MSSA infective endocarditis.