Background: Bacteraemia due to Staphylococcus aureus causes metastatic infective foci in different organs.
Case report: One year old baby with Acute Lymphoblastic Leukaemia with severe neutropenia got presented with fever. While on high risk induction, baby developed conjunctivitis in right eye with fever. Eye referral was done urgently suspecting metastatic endophthalmitis. Vitreous was sent for cultures and intravitreal vancomycin given. Baby was started on gentamicin and moxifloxacin eye drops. Vancomycin and fusidic acid intravenously were added. Blood culture grew Methicillin resistant Staphylococcus aureus (MRSA) and Candida tropicalis. Amphotericin B too was added. Vitreous too grew MRSA but fungal culture was negative. Eye review after five days showed improvement. Later, baby developed generalized skin rash with subcutaneous nodules. FNA of a nodule grew MRSA. No evidence of endocarditis. Chest radiography showed left sided pneumothorax. Computerized tomograpgy (CT) scan of chest showed l lung abscesses in both lungs with bilateral localized pneumothorax. Eye review after one week showed reduced right corneal haziness. CT brain showed no evidence of CNS involvement. Ultrasonography of abdomen was normal. Repeated urine cultures showed no growth. Vancomycin and fusidic acid were continued for seven weeks and amphotericin B for three weeks. Child recovered. He continues to have chemotherapy for his leukaemia during past 08 months. Haziness of his right eye persisted and regaining of vision in this eye needs to be assessed in the future.
Conclusion: Multidisciplinary approach with careful and timely evaluation is extremely valuable in managing neutropenic patients with severe sepsis for their successful recovery.