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A case of bilateral endogenous bacterial endophthalmitis from Streptococcus pneumoniae bacteraemia

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Clinical record

A 55-year-old woman was admitted to an orthopaedic unit of a metropolitan hospital in Australia with right shoulder septic arthritis. She had been experiencing 3 days of right shoulder pain, fevers, rigors and delirium. These occurred in the context of a right rotator cuff repair 3 months previously. Her medical history included hypertension, hypercholesterolemia and an L4-S1 spinal fusion for lumbar spine degeneration. Her medications included hydrochlorothiazide, olmesartan and atorvastatin.

On examination, she was febrile with a temperature of 38.9°C, with a painful, erythematous and swollen right shoulder with movement limited by pain. Her chest and abdominal examinations were normal. Her relevant admission blood test results were white cell count, 30 × 109/L (reference interval [RI], 4–11 × 109); neutrophil count, 21.9 × 109 (RI, 2–8 × 109); and C-reactive protein level, 438 mg/L (RI, 0–5 mg/L). Platelet, haemoglobin, uric acid and blood sugar levels were all normal. Her shoulder and chest x-rays were unremarkable. Several sets of blood cultures as well as a shoulder aspirate showed gram-positive cocci and she was empirically commenced on intravenous (IV) flucloxacillin 2 g four times a day and vancomycin 1.5 g twice daily.

Shortly after admission, she revealed that…