Presumed Aggregatibacter aphrophilus endogenous endophthalmitis

Abstract

We hereby report a case of endogenous endophthalmitis, presumably caused by a rare culprit—Aggregatibacter aphrophilus. A. aphrophilus is a member of the HACEK group, a group of fastidious Gram-negative bacteria with low pathogenicity and a rare cause of human infections. For ophthalmic infection, it has been reported to cause canaliculitis and exogenous endophthalmitis. A middle-aged gentleman with good past health presented with decreased vision (20/200) in his left eye. Other than fever, he was well on presentation, with no apparent focus of infection. Subsequently, he developed an episode of high fever reaching 39.2 °C, with CRP of 233 mg/L. CT abdomen showed presumed kidney abscess and a rare Gram-negative coccobacillus. A. aphrophilus [formerly Haemophilus aphrophilus (Nørskov-lauritsen and Kilian in Int J Syst Evol Microbiol 56:2135–2146, 2006)] was found in blood culture, Vitreous sample was analysed using 16S ribosomal DNA amplification but failed to identify the organism. After appropriate treatment, his vision improved drastically from 20/200 to 20/30. A. aphrophilus isolated from blood cultures during septicemia in a patient with kidney abscess may be associated with metastatic endophthalmitis, which may appear as a first sign. Our case demonstrates that with prompt diagnosis and appropriate treatment, visual prognosis of A. aphrophilus endophthalmitis can be promising.