Fulminant Bacillus Cereus Endogenous Panophthalmitis and Flood Water: A Case Report and Literature Review

Abstract

Bacillus cereus is a spore-forming Gram-positive bacillus found in soil and water that can cause severe ocular infections. This is a case of a 53-year-old woman with uncontrolled diabetes who developed sudden, painful vision loss in her left eye after flood exposure. Examination revealed no light perception, ophthalmoplegia, and elevated intraocular pressure (IOP) of 52 mmHg. Within eight hours, her condition worsened with severe proptosis, chemosis, and IOP rising to 87 mmHg, requiring emergency canthotomy and cantholysis. Blood cultures confirmed B. cereus, and blood tests showed leucocytosis and elevated C-reactive protein. Imaging revealed necrotizing infection with orbital gas. Despite intravenous antibiotics, the eye ruptured and evisceration was performed. She completed two weeks of antibiotics and recovered without systemic or intracranial spread. This case underscores the fulminant progression of B. cereus pan-ophthalmitis, the need for early intervention, and the importance of PPE during post-flood clean-up to prevent serious infections, particularly in vulnerable individuals.