Optic Pathway Abscess Caused by Clostridium septicum Endophthalmitis From Colon Adenocarcinoma Requiring Incision and Drainage of Optic Nerve and Chiasm.

BACKGROUND AND

IMPORTANCE

Optic pathway abscess formation is a rare clinical entity. To date, there are no reports of optic pathway abscess formation due to Clostridium septicum, secondary to colon adenocarcinoma. We present a video case report of a unique patient found to have C. septicum optic pathway abscess requiring craniotomy for incision and drainage of optic nerve/chiasm.

CLINICAL PRESENTATION: A 62-year-old woman presented with acute-onset right eye vision loss and rapidly progressive proptosis, chemosis, elevated intraocular pressure, and ophthalmoplegia requiring emergent canthotomy with cantholysis. MRI brain and orbits with and without contrast revealed enhancement of right posterior sclera and optic pathway. Despite broad spectrum intravenous antibiotics, the patient developed fever, encephalopathy, and left eye reduced vision. A right eye intravitreal tap and injection of antibiotics followed by eventual right eye evisceration was performed for source control. Both the intravitreal tap and evisceration cultures revealed C. septicum infection due to cecal adenocarcinoma. Subsequent imaging demonstrated progression of infection to abscess formation within the right optic nerve and chiasm. Craniotomy with incision and drainage of optic nerve revealed purulent material within the right optic nerve sheath. The patient's encephalopathy and imaging improved following drainage of abscess, and she was continued on extended course of antibiotics.

CONCLUSION

C. septicum endophthalmitis, often occurring due to colon adenocarcinoma, can progress to formation of optic pathway abscess. We present the rare case of C. septicum optic nerve/chiasm abscess formation requiring craniotomy for incision and drainage of the abscess, as detailed in the operative video.