Bilateral endogenous endophthalmitis in a patient after Intensive Care Unit hospitalization for acute respiratory failure due to Covid-19 pneumonia

Purpose
The aim of the study is to present a case of chronic bilateral endophthalmitis in a patient with a history of COVID-19 infection complicated by pneumonia and to discuss new diagnostic options in the field of molecular microbiology.

Summary
A 67-year-old woman reported to the ophthalmology department due to significant deterioration of vision in both eyes in the course of bilateral endogenous endophthalmitis, in order to have a pars plana vitrectomy (PPV) performed. Approximately three months earlier, the patient was hospitalized in the intensive care unit (ICU) for acute respiratory syndrome secondary to pneumonia caused by SARS-CoV-2 infection, confirmed by RTPCR nasopharyngeal swab. Due to the severe general condition, the breathing was supported by ventilation, central vascular catheterization and a Foley catheter were inserted, and broad-spectrum antibiotics, steroids and antiviral drugs were administered intravenously. In the Ophthalmology Department, posterior vitrectomy was performed in both eyes with collection of vitreous body for microbiological, virological and genetic tests. Using nanopore sequencing, the multifactorial bacterial etiology of right-side endogenous endophthalmitis was established.

Conclusions
A patient with suspected bilateral endogenous endophthalmitis requires urgent ophthalmological consultation, immediate general medical treatment and performance of PPV. Microbiological diagnostics of ophthalmic samples can be extended by whole-genome nanopore sequencing. Unlike traditional cultures, which are often negative, it allows quick identification of microorganisms, even in a small amount of genetic material.