A 50-year-old South Asian origin immunocompetent female with no significant past medical history presented with symptoms were of profuse diarrhea with abdominal cramps and high fever following consumption of meatballs and smoked salmon in the previous week. During the second day of symptoms she developed acute painful visual loss in her left eye. She had, retro-orbital pain and headache with conjunctival injection and watering. She was seen at an emergency eye clinic and uveitis was diagnosed. She was treated with steroid eye drops for two weeks. Vision initially improved then subsequently deteriorated despite a trial of oral prednisolone 30 mg OD for a further two weeks.
A month after her initial illness there was no improvement in her ocular symptoms. Her vision was counting fingers (CF) in her left eye and normal acuity in her right eye. Her left eye had a severe anterior chamber inflammatory activity, copious flare, keratic precipitates and hypopyon. The posterior fundus was not visible due to vitritis and debris, although the retina peripherally was seen to be flat and attached with indirect ophthalmoscopy. A diagnosis of endophthalmitis was made. A vitreous aspiration was performed and she was given an intravitreal injection of vancomycin and foscarnet. She was commenced on valacyclovir 2 g tds, trimethoprim/sulfamethoxazole (SXT) 960 mg bd for 2 weeks and prednisolone 80 mg od. The vitreous fluid had numerous polymorphs on microscopy, gram stain was negative. L. monocytogenes was cultured from vitreous humour. Further characterisation at the Gastrointestinal Bacteria Reference Unit, Colindale confirmed L. monocytogenes serotype 1/2a, which was fully sensitive to amoxicillin, gentamicin, SXT and vancomycin. She was admitted to hospital for further management. Surveillance blood cultures were negative, blood tests showed CRP <0.3 with normal CBC, LFTs and renal function. No immunodeficiency was identified. Transthoracic ECHO was normal and there was no evidence of any other metastatic infection.