Korean J Ophthalmol Vol.24, No.4, 2010 A B Fig. 2. Hypopyon in the anterior chamber of the right eye. Fig. 3. Pantoea agglomerans was isolated in the vitreous culture. Yellow pigment-producing colonies that were 2 mm in size, non- hemolytic, and convex were detected on a blood agar plate. pected ocular fungal infection. Despite this treatment, the an- terior chamber reaction and fundus findings deteriorated. Five days after the initial intravitreal injection, visual acuity of the right eye had decreased to hand motion. A hypopyon had also developed in the right eye (Fig. 2). 250 Fig. 1. (A) Right eye. Exudate was round, whitish-yellow, and slightly elevated towards the vitreous cavity. (B) Left eye. Exudates were irregu- lar, whitish-yellow, and slightly ele- vated towards the vitreous cavity. Nine days after admission the patient underwent a pars plana vitrectomy with cataract surgery in the right eye. Intravitreal gentamicin (20 μg/mL), cefazolin (50 μg/mL), amphotericin B (1.0 μg/mL), vancomycin (1 mg), and cefta- zidime (2 mg) were administered at the end of the surgery. Five days after the initial ocular presentation, P. agglomer- ans was identified in the vitreous culture, but the aqueous hu- mor and blood cultures were negative. Based on sensitivities, intravenous antibiotics (ciprofloxacin 200 mg every twelve hours and ampicillin sodium 500 mg every eight hours) were administered. The inflammation of the right eye gradually decreased in response to this therapy, but no response was observed in the left eye. On hospital day 24 the patient under- went a pars plana vitrectomy with cataract surgery in the left eye. All cultures of the vitrectomy specimens were negative. Ophthalmic findings in the left eye also improved. Six months after surgery the patient’s final visual acuity improved to 25/20 in the right eye and 20/200 in the left eye. An exudative scar of the paramacular area in his left eye was noted, but his symptoms were markedly improved. Discussion Endogenous bacterial endophthalmitis is a rare disease that occurs when microorganisms spread to the eye from a source elsewhere in the body, usually through the bloodstream. It accounts for only 2 to 6% of all cases of endophthalmitis [6]. In this case we initially believed that the infection was fungal in origin because of the clinical features, no history of ocular trauma, the presence of interstitial lung disease with a fever, and the prior administration of immunosup- pressive treatment. Early diagnosis and treatment were delayed and the inflammatory reaction worsened because this species of Enterobacteriace is refractory to antifungal agents. After aspiration of the vitreous, P. agglomerans was confirmed as the causative agent of the intraocular infection. Early de- tection of visual disturbances is important in patients who have received corticosteroids or immunosuppressive therapy. P. agglomerans (formerly named Enterobacter agglomer- ans) is a rare cause of endogenous endophthalmitis. Zeiter et