Prepapillary metastatic abscess in a case of subacute bacterial endocarditis.

The case of a 49-year-old woman is described in which the presenting symptom of subacute bacterial endocarditis was the rare condition of a prepapillary abscess. There was a rapid decrease in visual acuity in the patient's left eye 10 days after the onset of an influenza-like episode, and ophthalmological examination revealed a pus-containing formation covering the optic disc, star-figure exudates in the macula, and some retinal hemorrhages with white centers. These findings in a patient known to have old valvular stenosis indicated a diagnosis of subacute bacterial endocarditis which was confirmed by further investigation. Both forms of endogenous primary retinitis were present in the same eye, i.e. (1) acute suppurative metastatic retinitis in the form of a prepapillary abscess and (2) subacute focal retinitis with the characteristic Roth's spots. Intensive antibiotic treatment was instituted, and within one month the prepapillary abscess was resorbed, with a parallel improvement in the general condition of the patient.