Central Retinal Artery Occlusion from Streptococcus Gallolyticus Endocarditis

• Autor(a) principal: Serras-Pereira, R
• Data de Publicação: 2020
• Outros Autores: Hipólito-Fernandes, D, Azevedo, L, Vieira, L
• Tipo de documento: Artigo
• Idioma: eng
• Título da fonte: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
• Texto Completo: http://hdl.handle.net/10400.17/4053
• topic: CHLC OFT; CHLC MED; Aged, 80 and over; Female; Humans; Acetazolamide / administration & dosage; Administration, Intravenous; Administration, Ophthalmic; Administration, Oral; Anti-Bacterial Agents / administration & dosage; Antihypertensive Agents / administration & dosage; Ceftriaxone / administration & dosage; Echocardiography; Endocarditis, Bacterial / complications; Endocarditis, Bacterial / diagnosis*; Endocarditis, Bacterial / drug therapy; Endocarditis, Bacterial / microbiology; Hypothalamic Area, Lateral; Isosorbide Dinitrate / administration & dosage; Mitral Valve / diagnostic imaging; Mitral Valve / microbiology; Retina / diagnostic imaging; Retinal Artery Occlusion / drug therapy; Retinal Artery Occlusion / microbiology*; Streptococcal Infections / complications; Streptococcal Infections / diagnosis*; Streptococcal Infections / drug therapy; Streptococcal Infections / microbiology; Streptococcus gallolyticus / isolation & purification*; Tomography, Optical Coherence; Treatment Outcome

Central retinal artery occlusion (CRAO) is a rare but blinding disorder. We present a case of a 81-year-old woman with multiple cardiovascular comorbidities admitted to the emergency department due to sudden, painless vision loss on left eye (oculus sinister (OS)) on awakening. The patient also reported long standing fatigue associated with effort that started 4 months before admission. She presented best corrected visual acuity of counting fingers OS. Funduscopy OS revealed macular oedema with cherry red spot pattern. Blood cultures came positive for Streptococcus gallolyticus in the context of a bacteremia and native mitral valve vegetation identified on transoesophageal echocardiography. CRAO of embolic origin was admitted in the context of an infective endocarditis. CRAO can be the first manifestation of a potentially fatal systemic condition and thus multidisciplinary approach is warranted with close collaboration between ophthalmologists and internists in order to provide proper management and the best possible treatment.