A 62-year-old woman with a history of arterial hypertension (AHT) and type 2 diabetes mellitus (DM) treated with metformin, who began 24 hours before admission with general malaise, fever and progressive low back pain together with 38.5oC.
On examination, the patient was confused, with a tendency to sleep, feverish, with blood pressure values of 100/70 mmHg and 95 bpm.
From the point of view of my pupil, he presented in the right eye upper parpebral edema with ptosis of mechanical aspect, restriction to opacity and adduction due to orbital edema, conjunctival chemosis, transparent cornea.
The rest of the general examination was normal.
Blood tests showed hemoglobin 10.5 g/dl, 82,000 platelets/μL, 5020 leukocytes/μL, 82% neutrophils, glucose 402 mg/dl, normal glomerular sedimentation rate 1 133 hours.
Leukocytes/field were observed in urine.
Cerebrospinal fluid (CSF) showed 95 cells/mm3, 84% polymorphonuclear and 16% mononuclear, 77 mg/dl glucose and 125 mg/dl protein.
A CT scan and a cranial MRI showed no orbital alterations or malformations.
Magnetic resonance imaging of the spine revealed an image compatible with spondylitis at L4-L5.
Transthoracic and transesophageal echocardiography revealed no endocarditis.
Hemocultive, urocultive and CSF cultures were performed, isolated in all Escherichia coli, with the same susceptibility pattern in the antibiogram.
She was treated with ceftriaxone 2 g IV and ciprofloxacin 200 mg IV twice daily, along with topical treatment with neomycin, prednisone and atropine for 30 days oral plus 750 mg daily.
At the end of treatment, the capacity of light perception remained in the affected eye.
