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Cecocentral scotoma as the initial manifestation of subacute bacterial endocarditis

Authors Strauss, Baharestani S, Nemiroff, Amisur K, Howard D

Published 1 March 2011 Volume 2011:5 Pages 287—290

DOI https://doi.org/10.2147/OPTH.S16237

Review by Single-blind

Peer reviewer comments 2


Danielle Savitsky Strauss, Samuel Baharestani, Julia Nemiroff, Kiran Amesur, David Howard
New York University Langone Medical Center, New York, NY, USA

Introduction: We report a case of a 67-year-old male who presented with a cecocentral scotoma caused by a septic embolus from subacute bacterial endocarditis (SBE).
Methods: A 67-year-old man presented with sudden, painless decreased vision in the left eye. A dilated fundoscopic exam, Humphrey visual field test, transthoracic echocardiogram, abdominal computed tomography (CT), and blood cultures were all performed.
Results: A dilated fundoscopic exam revealed temporal segmental optic disc pallor on the left, and Humphrey visual field testing demonstrated a dense left cecocentral scotoma. When the patient developed fever (103.9°F) and palpitations, transthoracic echocardiogram revealed valvular vegetations, and contrast CT of the abdomen revealed an abscess in the dome of the liver likely due to an infectious thrombus. Blood cultures grew viridians group streptococci in three separate peripheral collections.
Conclusion: This case illustrates that a sudden cecocentral scotoma may be the initial manifestation of SBE.

Keywords: endocarditis, scotoma, streptococcal infections, visual fields

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