MRSA Panophthalmitis in a Brittle Diabetic: a Histopathologic Review

A 30-year-old male presented with bilateral eye swelling and methicillin resistant staph aureous(MRSA) bacteremia from an outside hospital. His past medical history included poorly controlled type 1 diabetes mellitus, end stage renal disease on dialysis, heart failure with reduced ejection fraction, and bilateral below the knee amputations. With worsening bilateral periorbital swelling as well as concern for intracranial involvement/spread and for scleral melt on the left eye, the patient was taken for left eye enucleation with wound drainage/antibiotic irrigation. The entire globe was represented in the slide and it shows extensive intra-ocular, scleral and episcleral acute inflammation with multifocal abscess formation. MRSA orbital cellulitis is an aggressive disease and generally caused by external trauma or injury that seeds the gram-positive organism posterior to the orbital septum, although it can also be caused endogenously through systemic infection. Bilateral blindness from community-associated MRSA orbital cellulitis has also been seen in the literature. We present a histopathologic review of a case of MRSA panophthalmitis.