Bilateral acute endophthalmitis associated with munchausen syndrome

Retin Cases Brief Rep. 2015 Spring;9(2):177-80. doi: 10.1097/ICB.0000000000000132.

Abstract

Purpose: Endophthalmitis is a potentially blinding intraocular infection that requires urgent intervention. Self-inflicted endophthalmitis is rare, difficult to diagnose, and requires a multidisciplinary approach for management. The purpose is to present a rare case of sequential self-inflicted acute endophthalmitis as a feature of Munchausen syndrome.

Methods: This is a case report reviewing imaging and laboratory studies.

Results: A 42-year-old female patient developed culture-proven acute endophthalmitis sequentially in both eyes with different bacterial strains. There was clear evidence of self-inflicted corneal puncture tracks in the right eye, and during the course of inpatient psychiatric evaluation, the patient admitted to self-inflicted ocular perforations.

Conclusion: Patients with Munchausen syndrome often injure themselves as a method of drawing attention, sympathy, or reassurance. Although ocular injuries due to psychiatric disease are known to occur, intraocular injection as a mode of self-injury is extremely rare. A high index of suspicion must be maintained when the reported history and clinical course are inconsistent.

Publication types

  • Case Reports

MeSH terms

  • Acute Disease
  • Adult
  • Endophthalmitis / diagnosis
  • Endophthalmitis / etiology*
  • Eye Infections, Bacterial / diagnosis
  • Eye Infections, Bacterial / etiology*
  • Eye Injuries, Penetrating / complications*
  • Eye Injuries, Penetrating / diagnosis
  • Female
  • Humans
  • Munchausen Syndrome / complications*
  • Munchausen Syndrome / psychology
  • Self Mutilation / complications*
  • Self Mutilation / psychology
  • Self-Injurious Behavior
  • Streptococcal Infections / diagnosis
  • Streptococcal Infections / etiology*
  • Streptococcal Infections / microbiology
  • Tomography, Optical Coherence
  • Viridans Streptococci / isolation & purification
  • Vitreous Body / microbiology