A 68-year-old immunocompetent male presented with sudden onset decreased vision, pain, and redness in the right (OD) eye since 1 day. The patient had been operated for reposition of exposed scleral-fixated intraocular lens (SFIOL) haptic 1 month back Fig. 1a.Figure 1: (a) Exposed nasal haptic of SFIOL pre-operatively (b) plenty of dot echoes on B scan at presentationAt presentation, the best corrected visual acuity in OD was perception of light. There was circumcorneal congestion, 2+ anterior chamber cells, and endothelial exudate deposits. The fundus view was obscured due to retrolental exudates. B-scan demonstrated a moderate number of low reflective mobile dot echoes in the mid-vitreous cavity Fig. 1b. Based on clinical features and imaging, a diagnosis of acute endophthalmitis was made. Aqueous tap demonstrated Gram-negative bacilli. He underwent vitrectomy with intraocular injection of Ceftazidime (2.25 mg in 0.1 ml Dexamethasone). Analysis of undiluted vitreous sample demonstrated Gram-negative bacilli Fig. 2a. Culture revealed cream-colored to yellowish mucoid colonies growing on blood agar Fig. 2b. The bacterium was identified as Weeksella virosa using the automated Microscan-Walkaway 40 plus system (Beckman Coulter Inc., USA). It was sensitive to Cefipime, Gentamycin, Amikacin, and Ceftazidime.Figure 2: (a) vitreous aspirate demonstrating plenty of gram negative bacilli (b) Cream-coloured to yellowish mucoid colonies on blood agarReappearance of vitreous echoes in postoperative B-scans Fig. 3 prompted additional injections of intravitreal ceftazidime on a pro-re-nata basis. However, there was persistent deterioration in clinical response. Subsequently, the patient developed total choroidal detachment and eventually phthisis bulbi.Figure 3: Choroidal detachment with numerous dot echoes noted on B scan after vitrectomy and multiple intravitreal injectionsDiscussion Weeksella virosa is a nonsaccharolytic, oxidase and catalase-positive, Gram-negative bacillus. It has been documented to cause pneumonia, bacteremia, peritonitis, and urinary tract infections.1 It is not a common cause of eye infections.2 This microorganism has been isolated predominantly from the genitourinary tract.3 Endophthalmitis, a vision-threatening condition, can lead to rapid vision loss if not managed emergently. The clinical presentation of Weeksella virosa endophthalmitis can be indistinguishable from other causes of acute bacterial endophthalmitis. To the best of our knowledge, only a solitary article has reported isolation of Weeksella virosa from vitreous samples in infectious endophthalmitis.4 A high degree of suspicion and microbiological identification is crucial for management. Author Contribution Dr. Anjali Sapar - Manuscript writing and review, patient consent acquisition. Dr. Abhjit Agre - Manuscript and literature review. Dr. Shankar Gaikwad - Microbiological analysis, manuscript review. Dr. Shveta Gadewar - Manuscript and literature review. Dr. Anmol Naik- Manuscript writing, review, literature search and patient management. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given his/her consent for his/her images and other clinical information to be reported in the journal. The patients understands that their name and initials will not be published, and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship: Nil. Conflicts of interest: There are no conflicts of interest.
Sapar et al. (Thu,) studied this question.