PRESENTING AUTHOR

To describe a case of acute post-traumatic Bacillus pumilus endophthalmitis.

A 27-year-old male presented with a corneal laceration caused by a baling wire while working on his farm. The injury had a one-day history and was initially evaluated at another institution. Visual acuity was hand movements. The cornea had a small self-sealed wound, the anterior chamber had a 0.5 mm hypopyon and fibrin, and a traumatic cataract was noted. A pars plana vitrectomy (PPV) was performed. During surgery, the anterior chamber was cleaned, and a phacoemulsification was performed. The fundus showed multiple small hemorrhages, periphlebitis, and the wound caused by the wire. Silicone oil was used. A diagnosis of acute post-traumatic endophthalmitis was confirmed. Intravitreal injections and drops of ceftazidime and vancomycin, along with oral moxifloxacin, were prescribed. Vitreous culture was positive for Bacillus pumilus. After one month, the infection resolved, and the silicone oil was extracted. One year later, a secondary Carlevale intraocular lens (IOL) was implanted, resulting in a final uncorrected distance visual acuity (UDVA) of 20/60 and corrected distance visual acuity (CDVA) of 20/33.

Bacillus species traumatic endophthalmitis represents a particularly devastating disease, accounting for approximately 9-45% of traumatic endophthalmitis, especially those associated with rural incidents. Treatment includes intravitreal antibiotics, and some authors advocate for the prompt use of PPV in such cases to improve outcomes.

This case report describes the successful management of acute post-traumatic endophthalmitis secondary to Bacillus pumilus with prompt PPV and antibiotics.