A 62-year-old woman with a history of arterial hypertension (AHT) and type 2 diabetes mellitus (DM) on treatment with metformin, who began 24 hours prior to admission with general malaise, fever up to 38.5 ºC, back pain and acute confusional symptoms, together with progressive loss of vision in the right eye. On examination, the patient was confused, sleepy, febrile, with blood pressure of 100/70 mmHg and 95 bpm. From the ophthalmological point of view, she presented upper eyelid oedema in the right eye with ptosis of mechanical appearance, restriction to elevation and adduction due to orbital oedema, conjunctival chemosis, transparent cornea, with the ability to perceive light and project focus, with myotic pupil with the appearance of synechiae, and an unexplorable fundus due to opacity of the media. The rest of the general examination was normal. Blood tests showed haemoglobin 10.5 g/dL, 82,000 platelets/µL, 5020 leukocytes/µL, with 82% neutrophils, glucose 402 mg/dL, glomerular sedimentation rate 133 mm in the first hour, and a C-reactive protein of 165 U/L. All other routine laboratory parameters were within normal limits. In urine, 30-40 leucocytes/field were observed. Cerebrospinal fluid (CSF) showed 95 cells/mm3, with 84% polymorphonuclear and 16% mononuclear, 77 mg/dl glucose and 125 mg/dl protein. A CAT scan and cranial MRI were performed, where no orbital or cavernous sinus alterations were observed. A spinal MRI showed an image compatible with spondylitis at L4-L5 level. A transthoracic and transesophageal echocardiogram did not reveal endocarditis. Blood cultures, urine cultures and CSF cultures were performed, and Escherichia coli was isolated in all of them, with the same sensitivity pattern in the antibiogram.
She received treatment with ceftriaxone 2 g i.v. and ciprofloxacin 200 mg i.v. twice daily, together with topical treatment with neomycin, prednisone and atropine for 30 days, continuing with oral ciprofloxacin 750 mg twice daily for 14 more days. At the end of treatment, the affected eye retained the ability to perceive light.