A generally healthy 63-year-old man in the New England area went to the hospital with a fever, cough, and vision problems in his right eye. What his doctors eventually figured out was that a dreaded hypervirulent bacteria—which is rising globally—was ravaging several of his organs, including his brain.
According to the man, the problems had started three weeks before his hospital visit, when he said he ate some bad meat and started having vomiting and diarrhea. Those symptoms faded after about two weeks, but then new problems began; he started coughing and having chills and a fever. His cough only worsened from there.
At the hospital, doctors took X-rays and computed tomography (CT) scans of his chest and abdomen. The images revealed over 15 nodules and masses in his lungs. But, that’s not all they found. The imaging also revealed a mass in his liver that was 8.6 cm in diameter (about 3.4 inches). Lab work pointed toward an infection. So, doctors admitted him to the hospital and provided oxygen to help with his breathing, as well as antibiotics. But, his chills and cough continued.
On his third day, he woke up with vision loss in his right eye, which was so swollen, he couldn’t open it. Magnetic resonance imaging (MRI) revealed another surprise: there were multiple lesions in his brain. (His brain lesions and eye at this point can be seen here. A later-stage image of his eye is further down in the story.) At that point, he was transferred to Massachusetts General Hospital. In a case report in this week’s issue of the New England Journal of Medicine, doctors went through how they solved the case and treated the man.
The key to the correct diagnosis was his eye, which kept getting worse. He seemed to have an infection inside his eyeball, affecting the jelly or aqueous parts of the inside (endophthalmitis). The most common cause of this is an eye injury or previous surgery that allows an infection-sparking germ to get in—but he had no such injury or surgery. Also, the condition of his eye was worse than that. He appeared to have panophthalmitis, which is a rare, extremely severe and rapidly progressing condition in which every part of the eye becomes infected.