Endogenous panophthalmitis in a patient with diabetic kidney disease on haemodialysis: A vision-threatening manifestation of systemic infection

Endogenous endophthalmitis is a rare but devastating complication of haematogenous infection, with a higher risk in patients with diabetes mellitus and end-stage kidney disease receiving maintenance haemodialysis (MHD). We report a 40-year old man with diabetic kidney disease on MHD through a tunnelled dialysis catheter who presented with acute painful visual loss and was diagnosed with endogenous panophthalmitis. Blood, catheter blood and catheter-tip cultures grew methicillin-resistant Staphylococcus aureus , confirming a catheter-related bloodstream infection with ocular metastatic spread. Despite prompt intravitreal, systemic and topical antimicrobial therapy and removal of the infected catheter, the affected eye progressed to phthisis bulbi with permanent blindness. This case highlights the potential for vascular access-related bacteraemia to cause catastrophic ocular infection in patients receiving haemodialysis. Early recognition of endogenous endophthalmitis, prompt source control and coordinated ophthalmological, nephrological, and infectious disease management are essential to optimise outcomes.