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( Kevser Kutlu Tatar ),( Sibel Serin ),( Ece Yigit Taskin ),( Betul Ayaz ),( Sema Ucak Basat ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1
Endogenous endophtalmitis (EE), a sight-threating emergency,has been reported as the 2-8% of all endophthalmitis cases. EE is most often associated with a diagnosed underlying medical condition, including DM, liver disease, cardiac disease, malignancy, in-dwelling catheters and intravenous drug abuse (IVDU). A woman, 69 year-old, diagnosed with EE was followed up in the ophthalmology clinic for vitrectomy, consulted due to abdominal pain, pyuria and high levels of cholestasis enzymes. The patient had DM, hypertension, and ischemic heart disease for the last decade and severe heart failure for the last month. She had femoral catheter for ultrafi ltration two weeks ago. She was transferred to the internal medicine clinic with the differential diagnosis of heart failure, acute cholecystitis and urinary tract infection. In the MRCP imaging following an abdominal US, a signal differentiation due to possible metastasis or abscess was identifi ed in the liver. Multiple calculus in the neck of the bile cyst and cystic duct, sludge in gallbladder, expansion in choledoch diameter and multiple calculus at the distal part of choledoch were detected. A bilobular and fi at contoured, 85x140mm lesion was found at the left adnexa. A third echocardiography in a month was performed for her recently diagnosed cardiac failure and 2/6 systolic murmur, which was detectable best from the mitral point. The last echocardiography showed %50 EF, intermediate-advanced mitral insufficiency and a mass-vegetation on mitral valve. TEE, performed afterwards, showed vegetation on mitral valve and the possibility of valve perforation. Due to the continuation of decompensation and total obstruction in circumfi ex artery seen on the coronary angiography, coronary bypass and vegetation removal operations were performed. In this case, we present a case which has almost all the etiological reasons together except IVDU and which was diagnosed as IE based upon the EE diagnosis.
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