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E. A. McCourt, E. M. Hink, J. Olson, N. Mandava, V. D. Durairaj, S. C. Oliver; Isolated Group B Streptococcal Endogenous Endophthalmitis Simulating Retinoblastoma in a Healthy Full Term Infant. Invest. Ophthalmol. Vis. Sci. 2010;51(13):5291.
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To describe the second case of endogenous endophthalmitis (EE) caused by Group B Streptocci (GBS) in a healthy newborn and the first case of GBS EE to mimic retinoblastoma.
Observational case report
Our patient was born at term to a healthy 18 year old mother. A prenatal vaginal culture at 35 weeks was positive for GBS, sensitive to both clindamycin and erythromycin. Intravenous clindamycin was administered for 24 hours prior to induction of labor. Two hours post partum the patient's mother developed chorioamnionitis and was treated with IV clindamycin and gentamycin for 24 hours.The patient presented to the emergency room at 6 days of life with leukocoria of the right eye. She had increased vasculature of the iris, a shallow anterior chamber, and no view to the posterior pole due to cataract. A B-scan at that time showed a single hyperechoic focus in the mid vitreous space at a reduced gain of 60dB was found, and concern was raised for retinoblastoma (see figure).An orbital MRI showed abnormal signal within the right globe, with linear signal intensities extending from the optic nerve through the vitreous, suggesting persistent fetal vasculature.Five days later, the patient developed angle closure glaucoma with IOPs into the 50s, vomiting, and irritability. Urgent enucleation of this blind and painful eye was performed the following day.An intraocular culture grew GBS resistant to both erythromycin and clindamycin. Cultures of her cerebrospinal fluid, blood, and urine were all negative; the baby was treated empirically with antibiotics and remains healthy.
Endogenous endophthalmitis (EE) caused by GBS has been reported 22 times in adults and 6 times in newborns, often occuring in patients with systemic disease.This is the second reported case of endogenous endophthalmitis caused by GBS in a healthy newborn and the first case of endogenous endophthalmitis by GBS in a newborn mimicking retinoblastoma and resulting in enucleation of a blind and painful eye. Endogenous endophthalmitis us a rare cause of leukocoria and pseudoretinoblastoma.
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