Combined endophthalmitis and orbital cellulitis in patients with corona virus disease (COVID-19)

Mohamed Farouk Sayed Othman Abdelkader, Ahmed Mohamed Kamal Elshafei, Mahmoud Mamdouh Nassar, Mostafa A Abu Elela, Raafat Mohyeldeen Abdelrahman Abdallah, Mohamed Farouk Sayed Othman Abdelkader, Ahmed Mohamed Kamal Elshafei, Mahmoud Mamdouh Nassar, Mostafa A Abu Elela, Raafat Mohyeldeen Abdelrahman Abdallah

Abstract

Purpose: To document the presentation of unilateral combined endophthalmitis and orbital cellulitis in patients with COVID-19 infection and study their prognosis.

Patients and methods: This interventional case series study included 9 patients referred to the Ophthalmology Department, Minia University Hospital with unilateral combined endophthalmitis and orbital cellulitis between April 2020 and March 2021. In addition to the COVID-19 work-up, all patients were subjected to full ophthalmological evaluation and managed according to their ophthalmic and systemic disease.

Results: The patients were 5 females and 4 males. They had clinical, laboratory and imaging findings that confirmed COVID-19 infection. All patients had unilateral endophthalmitis with orbital cellulitis and profound visual loss in the affected eye. Three patients died due to respiratory failure, while 6 patients recovered systemically. The survived patients developed atrophia bulbi in 4 patients and in 2 patients, the globe retained normal size but with complete visual loss.

Conclusion: Combined endophthalmitis and orbital cellulitis can be one of the early presentations of patients with COVID-19 infection with poor visual prognosis.

Trial registration: Clinical registration: clinicaltrials.gov identifier: NCT04456556 .

Keywords: COVID-19; Endophthalmitis; Orbital cellulitis.

Conflict of interest statement

The authors declare that they have no competing interests.

© 2021. The Author(s).

Figures

Fig. 1
Fig. 1
Clinical images of covid-19 patients with orbital cellulitis and endophthalmitis
Fig. 2
Fig. 2
B-scan ocular ultrasonography shows medium to highly reflective floaters and membranous echoes with loculated opacities in the vitreous cavity more condensed posteriorly with choroidal thickening
Fig. 3
Fig. 3
Axial orbital CT scan showing left orbital cellulitis with axial proptosis

References

    1. World Health Organization (WHO). Q &A on Corona viruses (COVID-19). . 2020
    1. Cascella M, Rajnik M, Cuomo A, et al. Features, evaluation, and treatment coronavirus (COVID-19) StatPearls Publishing; 2020.
    1. Hu K, Patel J, Patel BC. Ophthalmic manifestations of coronavirus (COVID-19) StatPearls Publishing; 2020.
    1. Daruich A, Martin D, Bremond-Gignac D. Ocular manifestation as first sign of coronavirus disease 2019 (COVID-19): interest of telemedicine during the pandemic context. J Fr Ophthalmol. 2020;43(5):389–391. doi: 10.1016/j.jfo.2020.04.002.
    1. Turbin RE, Wawrzusin PJ, Sakla NM, Traba CM, Wong KG, Mirani N, Eloy JA, Nimchinsky EA. Orbital cellulitis, sinusitis and intra, cranial abnormalities in two adolescents with COVID-19. Orbit. 2020;39(4):305–310. doi: 10.1080/01676830.2020.1768560.
    1. Chen L, Liu M, Qiao K, Qiao K, Huang T, Chen M, Xin N, Huang Z, Liu L, Zhang G, Wang J. Ocular manifestations of a hospitalized patient with confirmed 2019 novel coronavirus disease. Br J Ophthalmol. 2020;104(6):748–751. doi: 10.1136/bjophthalmol-2020-316304.
    1. Dockery DM, Rowe SG, Murphy MA, Krzystolik MG. The ocular manifestations and transmission of COVID-19: recommendations for prevention. J Emerg Med. 2020;59(1):137–140. doi: 10.1016/j.jemermed.2020.04.060.
    1. American Academy of Ophthalmology. New study finds possible link between sight-threatening eye infection and coronavirus. . (2020)
    1. Elshafei AMK, Sayed MF, Abdallah RMA. Clinical profile and outcomes of management of orbital cellulitis in upper Egypt. J Ophthal Inflamm Infect. 2017;7:8. doi: 10.1186/s12348-017-0126-3.
    1. Jackson TL, Eykyn SJ, Graham EM, Stanford MR. Endogenous bacterial endophthalmitis: a 17-year prospective series and review of 267 reported cases. Surv Ophthalmol. 2003;48(4):403–423. doi: 10.1016/s0039-6257(03)00054-7.
    1. Greenwald MJ, Wohl LG, Sell CH. Metastatic bacterial endophthalmitis: a contemporary reappraisal. Surv Ophthalmol. 1986;31(2):81–101. doi: 10.1016/0039-6257(86)90076-7.
    1. Connell PP, O'Neill EC, Fabinyi D, Islam FM, Buttery R, McCombe M, Essex RW, Roufail E, Clark B, Chiu D, Campbell W, Allen P. Endogenous endophthalmitis: 10-year experience at a tertiary referral Centre. Eye (London, England) 2011;25(1):66–72. doi: 10.1038/eye.2010.145.
    1. Vilela RC, Vilela L, Vilela P, Vilela R, Motta R, Possa AP, de Almeida C, Mendoza L. Etiological agents of fungal endophthalmitis: diagnosis and management. Int Ophthalmol. 2014;34(3):707–721. doi: 10.1007/s10792-013-9854-z.
    1. Chin MS, Hooper LC, Hooks JJ, Detrick B. Identification of α-fodrin as an autoantigen in experimental coronavirus retinopathy (ECOR) J Neuroimmunol. 2014;272:42–50. doi: 10.1016/j.jneuroim.2014.05.002.
    1. Zhou P, Yang XL, Wang XG, et al. A pneumonia outbreak associated with a new coronavirus of probable bat origin. Nature. 2020;579:270–273. doi: 10.1038/s41586-020-2012-7.
    1. Senanayake P, Drazba J, Shadrach K, Milsted A, Rungger-Brandle E, Nishiyama K, Miura S, Karnik S, Sears JE, Hollyfield JG. Angiotensin II and its receptor subtypes in the human retina. Invest Ophthalmol Vis Sci. 2007;48(7):3301–3311. doi: 10.1167/iovs.06-1024.
    1. Wagner J, Jan Danser AH, Derkx FH, de Jong TV, Paul M, Mullins JJ, Schalekamp MA, Ganten D. Demonstration of renin mRNA, angiotensinogen mRNA, and angiotensin converting enzyme mRNA expression in the human eye: evidence for an intraocular renin-angiotensin system. Br J Ophthalmol. 1996;80(2):159–163. doi: 10.1136/bjo.80.2.159.
    1. Napoli PE, Nioi M, d'Aloja E, Fossarello M. The ocular surface and the coronavirus disease 2019: does a dual 'Ocular Route' exist? J Clin Med. 2020;9(5):1269. doi: 10.3390/jcm9051269.
    1. Smitha KS, Deshmukh AV, Manjandavida FP, Babu K. Pediatric viral orbital cellulites secondary to H1N1 infection: a case report. Indian J Ophthalmol. 2019;67(7):1234–1235. doi: 10.4103/ijo.IJO_1549_18.
    1. Borne MJ, Shields JN, Shields CL, De Porter P, Ehya H. Bilateral viral endophthalmitis as the presenting sign of severe combined immunodeficiency. Arch Ophthalmol. 1994;112(10):1280–1281. doi: 10.1001/archopht.1994.01090220030013.
    1. Yoshida A, Obata H, Kawashima H. Cytomegalovirus uveitis with hypopyon mimicking bacterial endophthalmitis. Case Rep Ophthalmol Med. 2015;2015:48981. doi: 10.1155/2015/489813.
    1. Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497–506. doi: 10.1016/S0140-6736(20)30183-5.
    1. Riphagen S, Gomez X, Gonzalez-Martinez C, Wilkinson N, Theocharis P. Hyperinflammatory shock in children during COVID-19 pandemic. Lancet. 2020;395(10237):1607–1608. doi: 10.1016/S0140-6736(20)31094-1.
    1. DeBiasi RL, Song X, Delaney M, Bell M, Smith K, Pershad J, Ansusinha E, Hahn A, Hamdy R, Harik N, Hanisch B, Jantausch B, Koay A, Steinhorn R, Newman K, Wessel D. Severe coronavirus Disease-2019 in children and young adults in the Washington, DC, metropolitan region. J Pediatr. 2020;223:199–203.e1. doi: 10.1016/j.jpeds.2020.05.007.

Source: PubMed

Sponsorer og samarbejdspartnere

Medicinske tilstande

Narkotikainterventioner

3
Abonner