Listeria monocytogenes panophthalmitis: a novel strain follows a virulent course.

PURPOSE: To describe the findings and clinical course of a case of Listeria endophthalmitis as it progressed to panophthalmitis despite vitrectomy and intravitreal and systemic antibiotic therapy.

METHODS: A case report of Listeria endophthalmitis progressing to panophthalmitis with a brief retrospective review of the literature pertaining to Listeria-related eye infections and endogenous endophthalmitis.

RESULTS: A 70-year-old man presented with fulminant, hypertensive endophthalmitis and underwent pars plana vitrectomy, vitreous tap for Gram stain and culture, with intravitreal antibiotic injection and systemic intravenous antibiotic therapy, given the concern for an endogenous source. Despite this treatment, the patient progressed to no light perception vision with progressive orbital inflammatory signs. He then required enucleation with pathology, demonstrating an acute necrotizing panophthalmitis.

DISCUSSION: This case demonstrates the importance of a high index of suspicion for endophthalmitis in the setting of progressive uveitis despite titration of topical corticosteroid therapy while describing the preferred management and antibiotic regimen for patients with Listeria-related infections. Previous reported cases of Listeria endophthalmitis characteristically present as a hypertensive endophthalmitis with pigment dispersion and a dark hypopyon. If endophthalmitis is suspected, an anterior chamber paracentesis with Gram stain and culture can aid in earlier diagnosis, thus allowing for prompt, targeted therapy and improved outcomes.