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2019 OMIG Abstract

Injection Drug Use (IDU)-Associated Endogenous Endophthalmitis Masquerading as Uveitis

Christiaan A Rees PhD1, Preston M Luong MD2, Nikhil N Batra MD1,3, Michael E Zegans MD1,3
1Geisel School of Medicine at Dartmouth, Hanover, NH; 2Department of Ophthalmology, University of Washington School of Medicine, Seattle, WA; 3Section of Ophthalmology, Dartmouth-Hitchcock Medical Center, Lebanon, NH

Purpose: To describe a series of seven patients with a history of injection drug use (IDU) presenting with vitreous inflammation initially thought to represent uveitis, but eventually found to be more consistent with endogenous endophthalmitis.

Methods: This case series involves seven subjects with a history of IDU who presented to Dartmouth-Hitchcock Medical Center between 2015 and 2017 with visual complaints and were noted to have ocular exam findings consistent with vitritis. Relevant demographic data, past medical/surgical history, and social history were obtained from the patientsí records. Examination findings, including visual acuity, intraocular pressure, and fundoscopic findings, as well as microbiological data, including PCR of blood and vitreous cultures, were also included.

Results: Seven patients with a history of IDU presenting with a chief complaint of vision changes were found to have intraocular inflammation including vitritis on examination. Five of these seven patients were treated with steroids by the referring provider for suspected uveitis. Vitreous biopsy was obtained and all initial vitreous fluid cultures were negative for bacteria and fungi. However, four of the seven patients went on to have evidence of endogenous endophthalmitis including either repeat culture, microbial PCR, microbes seen on stains of vitreous material, or concurrent septic emboli elsewhere. All seven patients demonstrated clinical improvement after undergoing pars plana vitrectomy (PPV) in combination with intravitreal antibiotics and antifungal injection, suggesting an underlying infectious component. None of the patients required ongoing immunosuppression.

Conclusion: In conclusion, we hypothesize that these seven cases represent IDU-associated endophthalmitis masquerading as uveitis. The culture negative status of these cases is likely due to a delayed clinical presentation, leading to a low or absent titer of organisms at the time of vitreous sampling. Recognizing IDU-associated endogenous endophthalmitis as a potential masquerade syndrome of uveitis may prevent inappropriate treatment with immunosuppressive medications and alert the patientís medical team to consider other forms of septic emboli.

Disclosure: N


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