Fulminant Unilateral Pseudomonas aeruginosa Endogenous Endophthalmitis Secondary to Peripheral Venous Catheter-Related Bacteremia in a Full-Term Neonate: A Case Report

Endogenous endophthalmitis is a rare but devastating complication of neonatal sepsis, predominantly reported in premature infants with very low birth weight. We report fulminant unilateral Pseudomonas aeruginosa endogenous endophthalmitis in a seven-day-old full-term male neonate (gestational age 39 weeks, birth weight 3,200 g) following delivery complicated by maternal chorioamnionitis and acute fetal distress. The infection originated from a peripheral intravenous catheter-related bloodstream infection, confirmed by triple-concordant cultures of blood, catheter tip, and vitreous aspirate. Ophthalmic examination revealed intense periorbital edema, dense fibrinous hypopyon, diffuse corneal stromal edema, absent red reflex, and a superotemporal subconjunctival collection consistent with a scleral abscess. B-scan ultrasonography demonstrated severe vitritis with maintained retinal attachment. Despite immediate multimodal antimicrobial therapy including intravitreal vancomycin and ceftazidime, fortified topical antibiotics, and escalated systemic therapy, the clinical course was relentlessly progressive, culminating in established phthisis bulbi with complete absence of light perception at six months. This case broadens the recognized epidemiological spectrum of neonatal endogenous endophthalmitis and underscores the imperative for early ophthalmologic consultation in any neonatal intensive care unit-admitted neonate with confirmed bacteremia, irrespective of gestational age.