Paraneoplastic pemphigus associated with rapidly progressing endophthalmitis caused by Morganella Morganii: A case report

Paraneoplastic pemphigus/paraneoplastic autoimmune multiorgan syndrome: Part I. Clinical overview and pathophysiology

Paraneoplastic pemphigus/paraneoplastic autoimmune multiorgan syndrome (PNP/PAMS) is a highly fatal autoimmune blistering disease. The condition occurs in patients with underlying benign or malignant neoplasms, most commonly lymphoproliferative disorders. Both humoral and cell-mediated immunities contribute to the pathogenesis, and autoantibodies against plakin family proteins are characteristic. Patients typically present with severe stomatitis and polymorphous skin lesions, which are often resistant to treatment. Bronchiolitis obliterans (BO) is a frequent complication which contributes to the high mortality rate of PNP/PAMS. Given the rarity of this disorder and heterogeneity of clinical presentation, clinicians should maintain a high index of suspicion for PNP/PAMS to avoid delayed diagnosis. In this first part of a two-part continuing medical education (CME) series, risk factors, pathogenesis, and clinical features of PNP/PAMS are discussed.

A Rare Case of Fulminant Acute Postoperative Morganella morganii Endophthalmitis

PURPOSE

The authors present a case of a 60-year-old Indian female presented with sudden loss of vision in the right eye three days after an uneventful cataract surgery which revealed a rare organism and which was treated successfully.

METHODS

She was diagnosed with acute postoperative endophthalmitis with fulminant disease and on further work up, culture showed Morganella morganii (gram negative bacilli).

RESULTS

She was successfully treated with intravitreal imipenem, dexamethasone and vitrectomy. A review of literature was conducted to identify and discuss additional reports on similar cases. As per PubMed search with keywords "Morganella morganii endophthalmitis" this is the best achieved visual outcome to date in a case of acute post-operative Morganella morganii endophthalmitis.

CONCLUSION

Intravitreal imipenem can be considered to treat Morganella morganii endophthalmitis. Aggressive treatment in these patients can help in improving visual outcome.