BILATERAL ENDOGENOUS ENDOPHTHALMITIS DUE TO PSEUDOMONAS AERUGINOSA IN A NEONATE Hortensia Sanchez-Tocino, PHD, MD,* M. Rosa Sanabria, PHD, MD,* Jaume Catala-Mora, MD,† Ignasi Ju ¨rgens, PHD, MD,‡ Carmen Gonzalez-Armengod, MD,* M. Fernanda Oman ˜a-Alonso, MD* Background: Bacterial eye infections are rare in the neonatal population and usually come from exogenous spread. Eye infection due to Pseudomonas aeruginosa, although uncommon, may be a devastating disease, especially in premature infants. Methods: Retrospective review of the clinical chart of a 10-day-old newborn baby with bilateral endogenous Pseudomonas aeruginosa endophthalmitis. Results: The patient presented with leukokoria in both eyes 7 days after the onset of severe septicemia due to endophthalmitis in both eyes. The baby received systemic treatment with meropenem and vancomycin, which the cultured bacteria were susceptible to, but the infection progressed. Intravitreal ceftazidime treatment and later vitrectomy could not prevent complete retina detachment and the progressive evolution to phthisis. Conclusion: Aggressive therapy including systemic antibiotics, intravitreous antibiotic injection, and vitrectomy could not prevent a poor outcome leading to retinal detachment and blindness in both eyes. A discussion of the treatment options and a review of the literature are also included. RETINAL CASES & BRIEF REPORTS 2:190 –192, 2008 From *Rio Hortega University Hospital, Valladolid, Spain; †Sant Juan de De ´u Hospital, Esplugues de Llobregat, Barcelona, Spain; and ‡Institut Catala ` de Retina, Barcelona, Spain. B acterial eye infections are relatively rare in the neonatal population. Organisms reported as pathogenic causes include Pseudomonas aeruginosa, group B streptococci, Haemophilus influenzae type b, Staphylococcus aureus, Salmonella enteritidis, Strep- tococcus pneumoniae, and Neisseria meningitidis. 1 P. aeruginosa is a ubiquitous gram-negative rod found in soil, waste, sewage, and hospitals. Nosocomial sources include contaminated humidifiers, incubators, respirators, and hospital mops. 2 Ocular infections in the premature infant may come from exogenous or endogenous spread; 80% of reported cases of neonatal endophthalmitis are from exogenous sources. 2 In ex- ogenous endophthalmitis, conjunctivitis with dis- charge is the initial sign. Endogenous spread to the eye by means of septic metastasis in a baby with a blood culture positive for sepsis represents 20% of endophthalmitis cases; 40% of cases involving sepsis result in death. 2 P. aeruginosa has been identified as a causative organism in 75% of invasive neonatal eye infections. 3,4 We describe a case of bilateral endoge- nous endophthalmitis due to P. aeruginosa in a non- premature infant. Case Report A male infant was born at 37 weeks’ gestation by cesarean section. He was the only surviving fetus of a triplet pregnancy by in vitro fertilization. The other two fetuses died in the first trimes- ter. The baby weighed 2,750 g and had Apgar scores of 8 and 9 at Reprint requests: Hortensia Sanchez-Tocino, Department of Ophthalmology, Rio Hortega University Hospital, Avda. Cardenal Torquemada, 47010 Valladolid, Spain; e-mail: hsanchez@ auna.com 190