Perforated corneal ulcer with subsequent endophthalmitis in a patient with graft-versus-host disease.

PURPOSE: To describe a case of a perforated corneal ulcer leading to a bacterial endophthalmitis in a patient with graft-versus-host disease (GVHD).

METHODS

Clinical history and examination; slit-lamp photography; surgical intervention; laboratory evaluation including microbiology, polymerase chain reaction (PCR), flow cytometry, and cytopathology.

RESULTS

A diagnostic and therapeutic pars plana vitrectomy was performed. The vitreous aspirate was evaluated with microbiology; PCR for herpes simplex, herpes zoster, and cytomegalovirus; flow cytometry; and cytopathology. The patient received intravitreal antibiotics and antifungal and antiviral medication. The vitreous culture grew Staphylococcus epidermidis.

CONCLUSION

Patients with GVHD are at risk for corneal ulcers with subsequent perforation. Commensal ocular flora may seed the vitreous and cause an endophthalmitis. Patients with GVHD may develop a vitritis from many causes including viral, fungal, and bacterial etiologies or a relapse of their original disease. When patients with GVHD present with vitritis, consideration should be given to obtaining a large vitreous aspirate to establish the etiology.