Endogenous methicillin-resistant Staphylo-quiet orbit and healthy-appearing conjunctival status after CASE REPORT coccus aureus endophthalmitis secondary to axillary phlegmon : a case report

Endophthalmitis, a potentially devastating inflammatory condition of the vitreous and anterior chamber, can be either noninfectious or infectious. Infectious endophthalmitis is classified as exogenous or endogenous. Exogenous endophthalmitis occurs secondary to violation of the eye wall as a result of ocular surgery or trauma, with subsequent intraocular microbial inoculation. Endogenous endophthalmitis, which is less frequent, occurs via hematogenous spread of microorganisms to the eye from systemic infection, often in immunocompromised patients. Common infectious foci include meningitis, endocarditis, indwelling catheters, and skin wounds. A 56-year-old male presented with a 2-day history of new floaters in the right eye. Ocular history was significant for surgical repair of a complex rhegmatogenous retinal detachment of the left eye, leading to a blind, painful eye, for which he underwent evisceration 6 weeks prior to developing floaters in his right eye. Systemic review revealed a 1-week history of a flulike illness, with fever, shortness of breath, diffuse myalgia, and arthralgia. Social history was notable for cigarette smoking and inhaled cocaine use; however, he denied intravenous drug use. Ocular examination of the right eye demonstrated visual acuity of 20/200, a round and reactive pupil, and full extraocular movements. External and anterior segment examination revealed mild conjunctival injection, 0.3 mm hypopyon with 4þ anterior chamber cells, and trace nuclear sclerotic cataract. Posterior segment examination revealed moderate vitritis and a 2-disc diameter-wide, creamy white subretinal lesion with associated intraretinal hemorrhage, located in the superior midperipheral retina, suggestive of a subretinal abscess (Fig. 1). Lesion depth was confirmed with ocular coherence tomography (Fig. 2). Ocular examination of the left eye revealed a