Streptococcus dysgalactiae endocarditis presenting as acute endophthalmitis

Abstract

Endogenous endophthalmitis is a rare ocular infection affecting the vitreous and/or aqueous humours. It is associated with poor visual prognosis and its commonest endogenous aetiology is infective endocarditis. The causative organisms of endogenous endophthalmitis complicating endocarditis are mainly Group A or B streptococci. The identification of Group C and G streptococci such as Streptococcus dysgalactiae is comparatively uncommon and has only been reported in a few case reports or series. We therefore report a case of infective endocarditis caused by Streptococcus dysgalactiae first presenting with endogenous endophthalmitis, the most likely source being osteomyelitis of both feet in a patient with type I diabetes. The patient was treated with a course of intravenous benzylpenicillin, intravitreal antibiotics, bilateral below knee amputations and mitral valve replacement. She survived all surgical procedures and regained partial visual acuity in the affected eye.

Keywords: Endocarditis; Group C streptococcus; Group G streptococcus; endophthalmitis; streptococcus dysgalactiae..

Figure 1

Magnetic resonance imaging of both feet showing advanced Charcot joint with complete distortion of the normal anatomy. (A) On the left, an ulcer (arrow) is present on the plantar aspect of the mid/hindfoot with enhancing tissue extending to the bases of the lateral midfoot joints and previous intramedullary rod defect in the distal tibial metaphysis, suggestive of infection. (B) On the right, a large plantar ulcer (arrow) and associated osteomyelitis in the calcaneum, head of talus, remaining cuneiforms, and lateral metatarsal bases.

Figure 2

The transoesophageal echocardiography showing one of the two large vegetations (one was 1.6×1.1 cm, arrow) on the posterior leaflet of mitral valve with associated complex severe mitral regurgitation.