Endogenous Aeromonas Hydrophila Endophthalmitis in an Immunocompromised Patient 1 Hee Jin Sohn, MD, Dong Heun Nam, MD, Yeon Suk Kim, MD , Hae Jung Paik, MD, PhD Department of Ophthalmology, Gachon University Gil Medical Center, Incheon, Korea Department of Gastroenterology, Gachon University Gil Medical Center1, Incheon, Korea Purpose: To report a case of endogenous endophthalmitis due to Aeromonas hydrophila in a patient with distal common bile duct carcinoma and biliary sepsis. Methods: A 72-year-old woman with distal common bile duct carcinoma, obstructive jaundice, diabetes mellitus, and hypertension had a 1-day history of blurred vision, redness, and eye discharges in the right eye. An ophthalmic examination showed no light perception vision, increased intraocular pressure, severe corneal edema, severe anterior chamber reaction, exudative membranes on the anterior lens surface, and severe vitreal reaction. There was no ocular history of trauma, infection, or surgery in either eye. Results: Under the impression of endogenous bacterial endophthalmitis, immediate intraocular cultures and intravitreal antibiotic injections were performed, but the anterior chamber reaction, and the ultrasonogram findings were deteriorated. Evisceration was undertakened because of extrusion of the intraocular contents, and Aeromonas hydrophila was isolated by intraocular culture. Conclusions: Endogenous endophthalmitis due to Aeromonas hydrophila is rare, but has a rapid clinical course and a poor prognosis, despite of prompt diagnosis and management. Korean Journal of Ophthalmology 21(1):45-47, 2007 Key Words: Aeromonas hydrophila, Endogenous endophthalmitis, Immunocompromised The genus Aeromonas consists of gram-negative, facultatively anaerobic, rod-shaped, oxidase-positive bacteria that are widely distributed in the aquatic environment. In humans Aeromonas hydrophila may cause traumatic wound infection, gastroenteritis, and septicemia, especially in immuno- compromised hosts, but endogenous endophthalmitis caused by this agent is rare. Two reports of endogenous endophthalmitis have been described in immunocompetent patients.1,2 However, to the best of our knowledge, this is the first case of endogenous endophthalmitis caused by Aeromonas hydrophila in an immunocompromised patient. Case repo rt A 72-year-old woman with distal common bile duct carcinoma, obstructive jaundice, diabetes mellitus, and hypertension was admitted to our gastroenterology department. Received: February 17, 2006 Accepted: January 22, 2007 Reprint requests to Dong Heun Nam, MD. Department of Ophthal- mology, Gachon Medical School, 1198 Guwol-dong, Namdong-gu, Incheon 405-760, Korea. Tel: 82-32-460-3751, Fax: 82-32-460-3358, E-mail: eyedawns@gilhospital.com Two days after admission, ophthalmic consultation was sought to evaluate diabetic retinopathy. At initial examination, best-corrected visual acuity was 20/50 in both eyes with incipient cataract, but no sign of diabetic retinopathy. Moreover, there was no ocular history of trauma, infection, or surgery in either eye. Three days later, on day 5 after admission, the patient reported a 1-day history of blurred vision, redness, and eye discharge in the right eye. The patient was alert enough to have promptly reported her symptoms. Ophthalmic examination of the right eye showed a best-corrected visual acuity of no light perception, severe chemosis and injection of conjunctiva, and corneal haziness. Slit-lamp examination revealed an increased intraocular pressure of 30 mmHg, severe corneal edema, a shallow anterior chamber, severe anterior chamber reaction (many cells, flare, and RBCs), exudative membranes on the anterior lens surface, and a mid-dilated pupil (Fig. 1A). Fundus examination was obscured by severe vitreal reaction. A B-scan ultrasonogram showed moderate vitreous opacities (Fig. 1B). Ophthalmic examination of the left eye was unremarkable. Under the impression of endogenous bacterial endophthalmitis, immediate intraocular cultures (anterior chamber paracentesis 0.2 ml, vitreous needle aspiration 0.3 45