抄録
A 65-year-old man with a 6-year history of diabetes mellitus presented with left-sided sensory disorder, hemiparesis, and dysarthria. Magnetic resonance imaging (MRI) of the brain revealed multiple cerebral infarcts in the right cerebral hemisphere. Doppler ultrasonography, three-dimensional computed tomography angiography (3D-CTA), and MRI detected a 60% stenosis of the right cervical carotid artery resulting from a soft and lipid-rich plaque. The patient underwent right carotid endarterectomy (CEA) 3 months after the cerebral infarction had occurred. On postoperative day (POD) 7, he developed a high-grade fever and an elevated C-reactive protein (CRP). Blood cultures, chest and abdominal CT, and echocardiography did not reveal any evidence of infection. Although his CRP fell to 0.9 mg/dl on POD 20, the fever of unknown origin persisted in a remittent pattern. On POD 22, the patient experienced a severe headache around his left forehead, followed by a sudden onset of visual disturbance. He soon lost light perception in his left eye and became blind. Increased intraocular pressure and uveitis were noted. The ophthalmologist suspected endogenous bacterial endophthalmitis (EBE), and bacillus species bacteria were cultured from the hydatoid of anterior chamber and the peripheral blood. To prevent the spread of infection, he underwent enucleation of his left eye on POD 27.
We present a case of a rare complication of CEA. As the patient was noted to suffer from cholesterol crystal embolization after the onset of EBE, we hypothesize that the EBE might have resulted from an infected atherosclerotic plaque within the aortic arch or iliac arteries.
