Metastatic endophthalmitis: a rare complication of meningococcal meningitis.

Case report An 18-year-old girl previously healthy was admitted on 25 March 1971 with 2 days' history of headache, sore throat, pyrexia and vomiting. On examination she was conscious, coherent, had a temperature of 1030F, bilateral conjunctival redness, more marked in the right eye, photophobia, marked neck stiffness and a positive Kernig's sign. Throat was mildly congested. Cardiovascular system, chest and abdomen were normal. Blood pressure was 120/80. Neurological examination did not reveal any deficit. Investigations. CSF turbid, WCC 1000/mm3 with predominantly polymorphonuclear leucocytes, protein 300 mg/100 ml and sugar 30 g/100 ml. Gram stain showed Gram-negative diplococci both extra and intracellular, culture yielded N. meningitidis. Two blood cultures also grew N. meningitidis. Organisms were identified belonging to group C and were senstive to penicillin and sulphonamides. Nose, throat and conjunctival swabs yielded no growth of N. meningitidis. Hb 11 9 g/100 ml, WCC 12000/mm3, 87% polymorphonuclear leucocytes. Blood urea, electrolytes, X-ray chest and electrocardiogram were within normal limits. Treatment and progress. The patient was given 30 mega units of penicillin G in half strength Hartman's solution intravenously/24 hr. On 26 March she developed pain and loss of vision in her right eye. She was seen by the consultant ophthalmologist who noted signs of severe uveitis with considerable exudation into the anterior chamber and diagnosed metastatic endophthalmitis. Her therapy was changed to 20 mega units of penicillin G and sodium sulphadimidine 8 g intravenously/24 hr with local instillation of gutt. penicillin BPC and gutt. atropine 1%. every 4 hr. Vision in the right eye and signs of meningitis improved gradually. This therapy was continued for 14 days. On 30 March she developed herpes labialis which responded satisfactorily to local application of 570 idoxuridine in dimethyl sulphoxide solution. At the time of discharge on 22 April her vision in the right eye was 6/6 with some degree of residual posterior uveitis and she had no neurological deficit.