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An outbreak of Ralstonia pickettii endophthalmitis following intravitreal methotrexate injection

Authors Choudhury H, Jindal A, Pathengay A, Flynn Jr H

Received 19 January 2015

Accepted for publication 28 February 2015

Published 23 June 2015 Volume 2015:9 Pages 1117—1120


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 6

Editor who approved publication: Dr Scott Fraser

Himadri Choudhury,1 Animesh Jindal,1 Avinash Pathengay,1 Harry W Flynn Jr2

1LV Prasad Eye Institute, GMR Varalakshmi Campus, Visakhapatnam, India; 2Department of Ophthalmology, Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, FL, USA

Purpose: To report an outbreak of endophthalmitis in three eyes of two patients following intravitreal methotrexate, caused by Ralstonia pickettii.
Design: Retrospective, noncomparative, consecutive case series.
Methods: Medical records and microbiology results of two patients who presented with acute endophthalmitis following intravitreal methotrexate injection in November 2013 were reviewed.
Results: Following intravitreal injections, the patients experienced pain and decrease in vision in the affected eye within 24 hours of receiving intravitreal methotrexate injection. The presenting visual acuity in case 1 was 20/50 in the left eye. The presenting visual acuity in case 2 was hand motions in the right eye and counting fingers at 1 m in the left eye. Both the patients received methotrexate prepared in the same manufacturing facility. Both the patients underwent vitreous biopsy and intravitreal injection of vancomycin 1 mg/0.1 mL, amikacin 400 µg/0.1 mL, and dexamethasone 400 µg/0.1 mL. Microbiology cultures from vitreous, and used and unused vials of methotrexate from the same batch grew R. pickettii. After 8 months of follow-up, both the patients had visual acuity 20/60 or better.
Conclusion: R. pickettii can be rarely associated with outbreak of endophthalmitis. Timely intervention can be associated with good visual outcome in such patients.

Keywords: Ralstonia pickettii, intravitreal injection, intravitreal methotrexate

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