Discussion:
Brucellosis is a zoonotic disease that can be found worldwide. Although it has been eradicated and is under control in most developed countries, it still represents an important health problem in many parts of the world, including the Middle East, the Mediterranean, Mexico, and Central and South America5. In some countries, such as Peru, Kuwait, Saudi Arabia, and Iran brucellosis is endemic6,7.
Brucellosis presents with a spectrum of clinical manifestations, and diagnosis is based on clinical signs and positive bacteriological and serological tests. Ocular involvement caused by Brucella remains poorly recognized. Some ocular manifestations include dacryoadenitis, episcleritis, chronic sclerouveitis, nummular keratitis, cataract, glaucoma, multifocal choroiditis, exudative retinal detachment, maculopathy, and optic neuritis8,9.
Cavallaro et al . reported a patient with papilledema due to brucellosis treated with sole anti-brucellosis without steroid administration10. Lashay et al . from Iran reported a case of bilateral optic nerve head swelling following brucellosis, which led to bilateral optic nerve atrophy and visual loss11.
Endogenous endophthalmitis is an ophthalmic emergency that can have severe sight-threatening complications and still presents a diagnostic and therapeutic challenge even with improvements in therapeutic modalities. The main prognostic factor is the virulence of the causative organism: once the organism enters the eye, it rapidly destroys ocular tissues. However, it should be considered that our patient’s poor outcome could also be related to sequelae of endophthalmitis such as RRD and proliferative vitreoretinopathy (PVR) than the high virulence of the organism. Endogenous endophthalmitis is one of the manifestations of brucellosis which is spreading from ocular blood circulation. The diagnosis of brucella endophthalmitis may be quite challenging and requires a high index of suspicion in the absence of characteristic systemic features. Regarding a 1.3% false positive rate for serology assessment for the diagnosis of brucellosis, we considered other differentials such as fungal, bacterial, and tuberculosis-related endogenous endophthalmitis12. However, the patient’s systemic work-ups end in brucellosis. The point to notice in this case is the occurrence of endophthalmitis about four months after the patient’s systemic symptoms. Orey et al. reported a 26-year-old female with the final diagnosis of brucella endogenous endophthalmitis, which was treated with high-dose systemic corticosteroids and azathioprine with an initial misdiagnosis elsewhere. They concluded that the diagnosis of brucellosis should be considered in any case of panuveitis of unknown origin in endemic areas7.
While previous studies have shown an appropriate response to treatment in patients with Brucella endophthalmitis11, in this article, we reported a patient with fulminant endogenous endophthalmitis following brucellosis, which had a poor visual prognosis and is prone to phthisis bulbi despite our therapeutic efforts.