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Actinomyces israelii endogenous endophthalmitis
  1. Tatyana Milman1,2,
  2. Neena Mirani1,2,
  3. Therese Gibler3,
  4. Russell N Van Gelder3,
  5. Paul D Langer1
  1. 1
    Institute of Ophthalmology and Visual Science, New Jersey Medical School, Newark, New Jersey, USA
  2. 2
    Department of Pathology, New Jersey Medical School, Newark, New Jersey, USA
  3. 3
    Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St Louis, Missouri, USA
  1. Dr Paul D Langer, Institute of Ophthalmology and Visual Sciences (IOVS), Department of Ophthalmology, 90 Bergen Street, Doctors Office Center, Suite 6100, Newark, NJ 07101, USA; planger{at}umdnj.edu

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Actinomyces species are anaerobic Gram-positive pleomorphic rods that are commensals of the oral flora and facultative pathogens.1 In ophthalmological practice, Actinomyces are typically associated with canaliculitis. Although these organisms have rarely been described as causative agents of postoperative endophthalmitis, they have not yet, to our knowledge, been associated with endogenous endophthalmitis.2 3

Case report

A 74-year-old woman with diabetes experienced acute unilateral visual loss one week after a dental procedure. Initial examination was remarkable for light perception vision and dense vitritis in the right eye.

Despite two vitrectomies with intravitreal vancomycin and ceftazidime injections, and a course of oral steroids, the endophthalmitis progressed, leading to blindness in five months. Diagnostic work-up included microbiological and cytological evaluation of two vitreous biopsies, and systemic investigation for a source of metastatic endophthalmitis (including whole-body positron emission tomography/computed tomography …

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