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Abstract

Introduction: Vision an important sense organ for every person. A disease can be so threatening that it can take away a child’s vision. In this report we see how a liver pathology can effect eye (endophthalmitis) liver an endocrine gland required for many functions of the body. Failure of it can be acute or chronic or fulminant. Fulminant hepatic failure is defined as condition in which coagulopathy and encephalopathy occurs within 8 weeks of onset of liver disease, in a patient with no previous liver disease, biochemical evidence of liver injury, coagulopathy not corrected by vitamin k administration, INR>1.5 with encephalopathy, INR>2 without encephalopathy are criteria proposed for diagnosis. Endophthalmitis infection of inner eye (vitreous and anterior chamber) can be exogenous or endogenous. Exogenous is because of external trauma, foreign body, post-surgery, that can cause bacterial or fungal infection. Endogenous endophthalmitis is because of hematogenous spread usually seen in immune compromised or children on steroid therapy etc.

Case Report: A 4 year old child came with complaints of fever since 11days, convulsions since 5 days sudden onset, GTCS type lasting for 10 to 15 mins, 2 to 3 episodes per day, vomiting since 2 days. on examination child was not conscious with a GCS of E2V1M4, pupils mid dilated, vitals- PR-102/min RR- 22/min, B.P-100/60mm of hg,TEMP-101 0F pallor present mild icterus present, head to toe examination normal, on systemic examination revealed motor hypotonicity, reflexes exaggerated, no signs of meningitis. Investigations revealed deranged coagulation profile (INR – 2.8) and raised liver enzymes, raised ammonia levels, with increased total counts, negative for all hepatic viruses, lumbar puncture normal, MRI was normal, immune globin levels normal, ANA profile normal. With anti-oedema measures and NAC infusion antiviral acyclovir therapy and symptomatic treatment, gradually child improved gcs normal but there was persistent fever and redness of eye developed on 3rd day of admission, on ophthalmic evaluation, redness of conjunctiva, hypopy on, it was proved that child had endogenous endophthalmitis of right eye, for which core vitrectomy was done and placed with an artificial prosthesis, now the child is blind in one eye. A unusualcase of fulminant liver failure with endogenous endophthalmitis.

Discussion: Fulminant hepatic failure is life threatening condition. And an unknown and rare complication seen in this condition is endogenous endophthalmitis, a study done by change sue showed the association of endopthalmitis with pyogenic liver abscess, studies have shown association between staph aureus and liver infections, also how staph aureus can cause endophthalmitis. So now that a rare case scenario is seen it is duty of doctor to be well aware of the complication when a liver pathology is involved. That could save any limitation of child’s health and vision.

Biography

Meghana Nannapaneni currently pursuing my Masters in Pediatrics from the prestigious Rajiv Gandhi University of Health Sciences, Bengaluru, India. I was honoured for securing distinctions in ophthalmology and otolaryngology and my prime area of interest has always been Neonatology. As a post graduate student, I have proactively presented oral papers and poster presentations in my State and National conferences and had received an award for an oral paper presentation in the state. When I am not into Books and patients I take timeout for sports like tennis and swimming. I have always been fascinated by how medicine is evolving and wanted to make my own contribution to it specifically in the field of Neonatology and be a Beacon of inspiration to my predecessors.