pISSN: 1011-8942 eISSN: 2092-9382 Korean J Ophthalmol 2010;24(4):249-251 DOI: 10.3341/kjo.2010.24.4.249 Case Report A Case of Bilateral Endogenous Pantoea Agglomerans Endophthalmitis with Interstitial Lung Disease Susie Seok1, Young Jun Jang1, Seung Woo Lee1, Ho Chang Kim1, Gyoung Yim Ha2 1Department of Ophthalmology, Dongguk University College of Medicine, Gyeongju, Korea 2Department of Clinical Pathology, Dongguk University College of Medicine, Gyeongju, Korea We here in report a case of bilateral endogenous endophthalmitis caused by Pantoea agglomerans (P. agglomer- ans) in a patient who had interstitial lung disease and was treated with oral corticosteroids. A 72-year-old man pre- sented with decreased visual acuity in both eyes nine days after he received oral corticosteroids. He had marked uveitis, cataracts, and vitreous opacities. Cultures were taken of blood, aqueous humor, and vitreous. We initially suspected a fungal etiology and treated him with antifungal drugs; however, the intraocular disease progressed without improvement. Vitreous culture was positive for P. agglomerans. The patient underwent pars plana vi- trectomy with cataract surgery bilaterally, followed by a 2-week course of antibiotics. The final visual acuity was 20/25 in the right eye and 20/200 in the left eye. This is the first report of bilateral endogenous endophthalmitis caused by P. agglomerans in Korea; it is also the first case reported outside of the United States. Key Words: Endophthalmitis, Pantoea Bilateral endogenous endophthalmitis is a rare but devas- tating disease. It results from hematogenous spread from a septic focus distant to the eye. Immunocompromised states such as diabetes mellitus, malignancy, and chemotherapy are associated with reduced host defense and are risk factors for developing endogenous endophthalmitis. Pantoea agglomerans (P. agglomerans) belongs to the species Enterobacteriaceae, which are gram-negative facul- tative anaerobes. It is commonly found in plants, soil, water, and foods. It can cause epidemics among hospitalized patients when associated with the use of contaminated intravenous products due to its ability to grow in commercial infusion flu- ids [1,2] and is rarely recognized as an agent of endogenous nosocomial infections [3-5]. We report the first case of bi- lateral endogenous endophthalmitis caused by P. agglomer- ans in a patient who had interstitial lung disease and was treated with oral corticosteroids. Received: May 12, 2009 Accepted: August 12, 2009 Reprint requests to Ho Chang Kim. Department of Ophthalmology, Gyeongju Hospital, Dongguk University College of Medicine, #1090-1 Seokjang-dong, Gyeongju 780-350, Korea. Tel: 82-54-770-8256, Fax: 82-54- 772-9618, E-mail: ophho@hanmail.net Case Report A 72-year-old male patient with interstitial lung disease presented to a local clinic because of difficulty breathing and a subjective fever. He had a fever of 39℃. The fever went down to 37℃ with the administration of antibiotics; the pa- tient was then given oral corticosteroids (predinisolone 60 mg/day). Nine days after admission to a local clinic he devel- oped blurred vision in both eyes; however, ophthalmic ex- amination was not performed initially. Three days after this decrease in visual acuity he was referred to our hospital. On initial examination, bilateral visual acuity was finger counting. There was no history of ocular trauma prior to admission. Anterior segment examination revealed severe conjunctival injection, severe anterior chamber reaction without hypo- pyon, and mild complicated cataracts in both eyes. Fundus examination revealed a vitreal reaction and multiple whit- ish-yellow exudates in both eyes. A single exudate was seen in the right macula and multiple exudates were observed in the left macula (Fig. 1). We initially suspected a fungal infection, such as candida, given his history and fundus findings. Cytological examina- tion and cultures of the blood, aqueous humor, and vitreous were ordered. Intravitreal vancomycin (1 mg), amikacin (200 μg), and amphotericin B (5 μg) were then injected into both eyes. Oral ketoconazole (400 mg/day) was given for the sus- ⓒ 2010 The Korean Ophthalmological Society This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses /by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. 249