1. 56-years-old man asked us for painless visual loss in his left eye.
CENTRAL RETINAL ARTERY OCCLUSION (CRAO) AS THE INITIAL MANIFETATION OF INFECTIVE ENDOCARDITIS
José María Ortega Molina, Maria del Carmen Gonzalez Gallardo, Ana María Solans Pérez de Larraya, María Jesús Chaves Samaniego. Hosp. Universitario San Cecilio (Granada).
56-years-old man asked us for painless visual loss in his left eye.
Background: urinary infection in treatment. No infectious diseases known.
Exploration:
VA OD: 1.
OS: amaurosis.
BMC: normal.
FE: Yellowish-white retinal foci around the macula in his OD and CRAO in his OS 1

2. DIAGNOSIS: CRAO OS, SUSPICION SEPTIC EMBOLI OU
OCT:
OD: Retinal septic focus
FA:
OD: Normal
OS: Macular ischaemia
DIAGNOSIS: CRAO OS, SUSPICION SEPTIC EMBOLI OU 2

3. All blood tests performed presented normal ranges.
Clinical evaluation was completed by an internist with diagnosis of infective endocarditis.
The patient received treatment with ceftriaxone+linezolid with good response and underwent heart surgery with mitral valve replacement.
The microbiologist culture of the valve revealed an infection due to Aerococcus Urinae.
Six month later
Macular ischaemia and disc pallor in OS and no signs of active infection foci in OD.

4. A B A.OS: Acute edema in the fiber layer due to CRAO.
B. OS: Edema dissapears leaving retinal atrophy after 6 months.

5. CONCLUSIONS:
Infective endocarditis has many different forms of presentation and a high clinical suspicion is often required to reach the diagnosis. CRAO due to infective endocarditis is rare and the prognosis for vision is poor.
BIBLIOGRAPHY:
1. Ziakas NG, Kotsidis S, Ziakas Al. Central retinal artery occlusion due to nfective endocarditis. Int Ophthalmol Apr; 34(2):315-9.
2. Wathek C, Kharrat O, Maalej A, Nafaa MF, Rannen R, Gabsi S. Ophthalmic artery occlusion as a complication of infectious endocarditis. J Fr OphthalMol Dec;37(10)e161-3 5