Rare manifestations of Streptococcus pneumoniae infection; the first case report in Thailand and literature review of pneumococcal endophthalmitis and endocarditis.

We report a case of endogenous endophthalmitis and endocarditis caused by a rare causative organism: Streptococcus pneumoniae. A 69-year-old woman with diabetes mellitus and pre-existing mitral regurgitation presented with acute fever and severe left eye pain. Ophthalmologic examination revealed bilateral endophthalmitis. Blood and vitreous fluid culture grew penicillin-susceptible S. pneumoniae. Transesophageal echocardiogram documented a 5-mm oscillating mass at right coronary cusp of aortic valve. After 4 weeks of combined ceftriaxone and levofloxacin therapy, the patient improved and was later discharged with blindness in her left eye.