Bilateral Fulminating Endophthalmitis With Streptococcal Septicaemia

ACUTE and irrecoverable blindness due to bilateral intra-ocular inflammation is fortunately rare in clinical practice.The case to be described was noted for the catastrophic occurfence of such an inflammation, associated with a streptococcal septicaemia, and was of such severity as to suggest the existence of an ocular hypersensitivity to streptococci or their products.Case Report A married woman, aged 45, was admitted under the care of Mr. John Winstanley on October 26, 1960, with sudden blindness and fever.History.-Normally a healthy person, she had experienced a sore throat and diarrhoea a fortnight before admission which cleared up quickly, to be followed a week later by rigors, headache, and thirst which necessitated a return to bed.This was soon followed by almost complete blindness and the occurrence of tender red patches on her elbow and foot.She was then admitted to hospital.Family History.-At the outset her husband and two children had also suffered brief episodes of sickness and diarrhoea.Examination.-Pulse120, temperature 103-00 F., respiration 22.She appeared toxic, but was rational and co-operative, although it was evident that she was quite blind.Herpetic ulceration of her lips and tongue were prominent features.There were tender patches of erythema on her elbow and foot.The visual acuity was perception of light in each eye with accurate projection.Both eyes presented an identical picture of congestion, with lustreless comeae and large hypopyons with clumps of cells adhering to the back of the corneae above.The anterior chambers were cloudy and the pupils already fixed to the lens capsules.The tension' was normal in each eye and there was no pain, lid oedema, chemosis, proptosis, or restriction of ocular movements.No view of the more posterior structures was obtainable.Diagnosis.-Septicaemia with complicating endophthalmitis. Laboratory InvestigationsBlood Count (on admission): Haemoglobin 60 per cent., W.B.C. 22,300 cu.mm., neutrophils 96 per cent., lymphocytes 3 per cent., monocytes 1 per cent., erythrocyte sedimentation rate 107 mm./l hr (Westergren).Blood Culture: Of twelve bottles, three on three separate occasions grew #-haemolytic streptococci of Lancefield group A.