Endogenous Bacillus cereus Panophthalmitis in a Patient with Chronic Kidney Disease: A Case Report

Clinical FindingsThe left eye had lid edema, proptosis, chemosis, and discharge, with restriction of extraocular movements.On testing vision, there was loss of perception of light.Exudate was noted in the anterior chamber.Computed tomography (CT) of the orbit showed features of left eye endophthalmitis with orbital and preseptal cellulitis.Systemic evaluation showed raised total counts and inflammatory markers.The right eye was unaffected. Diagnostic AssessmentEvisceration of the left eye was done on the same day.The next day, blood cultures flagged and were noted to have grampositive bacilli (GPB) (two out of four bottles), with the Gram stain morphology resembling aerobic spore-bearing GPB.Blood agar grew large, matte colonies exhibiting -hemolysis (Fig. 1).The isolate was identified as B. cereus by MALDI-TOF (matrix-assisted laser desorption ionization-time of flight) mass spectrometry.Eviscerated eye tissue sent for culture also yielded morphologically similar colonies (from broth culture/enhanced culture of tissue) which were identified by MALDI-TOF to be B. cereus.Bacillus species are common laboratory contaminants.Hence, differentiating cases of true infection can be challenging.In this case, two bottles of blood (one each of two different sets sent 1-