Okuläre Bakteriose bei einem Patienten mit aplastischer Anämie

BACKGROUND For more than a century it has been recognized that bacteria may infect the eye by way of the blood stream. Until fifty years ago, eyes so afflicted nearly always were blinded and a majority of the victims died from overwhelming sepsis. Although effective antibiotics are available today the prognosis is still guarded. CASE REPORT A 39-year-old physician died 6 years after he was diagnosed for idiopathic aplastic anemia. He had developed pseudomonas aeruginosa bacteremia and later a therapy refractive pneumonia caused by aspergillus which had led to respiratory failure. The patient had experienced a marked loss of visual acuity in his left eye ten days before he died. Ophthalmic examination at that point displayed signs of endophthalmitis, hyphaema, and heterochromic irises. The eyes were obtained postmortem and histologic examination of the left eye displayed numerous bacilli forming cuffs around blood vessels and a sheet between the necrotic retinal pigment epithelium and Bruch's membrane. No inflammatory response to the bacilli was present. The bacilli could be demonstrated with a Giemsa stain and could also be identified with electron microscopic examination. DISCUSSION The histologic results in our patient displayed numerous bacilli without inflammatory reaction which was a result of the aplastic state. Therefore, this disease was classified as "ocular bacteriosis". The blood-ocular barrier undergoes direct assault with intraocular inflammation and the impermeability to blood-borne antibiotics is lost. However, with the lack of an inflammatory reaction the permeability to antibiotics may be too low and the achieved concentration insufficient.