Version 2: Isolated Neisseria meningitidis-associated endophthalmitis in an immunocompetent host: case report and literature review

Introduction: Neisseria meningitidis is a Gram-negative diplococcus with significant infectious sequelae including meningitis and disseminated meningococcal bloodstream infection. Rarely has it been reported in the context of endophthalmitis without central nervous system involvement. We report a clinical case of isolated meningococcal endophthalmitis in an immunocompetent patient and present a literature review on published cases including treatment regimens and clinical outcomes. 

Case Presentation: A 51-year-old male with no significant medical history presented to the emergency department with acute vision loss in the right eye after returning from Mexico. Ophthalmic examination was consistent with endophthalmitis, presumed to be endogenous in the absence of recent ocular trauma or surgery. Vitreous culture was positive for growth of gram-negative diplococci, subsequently identified as Neisseria meningitidis. Blood and cerebrospinal fluid cultures were negative for growth of similar or implicative pathogens. There was no evidence of disseminated meningococcal infection; imaging did not demonstrate any drainable collections or sequelae of extension into the central nervous system. The patient was treated with intravitreal antibiotics as well as topical steroids and antibiotics. In addition, he completed a two-week course of systemic antibiotics. Visual outcome was unfortunately poor. 

Conclusion: This case illustrates a rare case of isolated endophthalmitis secondary to meningococcus, presumably from nasopharyngeal source. In these clinical scenarios, clinicians should perform a thorough evaluation for predisposing immunodeficiencies.