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.