Case of infectious endocarditis predicted by orbital color Doppler Imaging

Background: There are no specific ocular findings for infectious endocarditis. We report a case of infectious endocarditis detected by combining orbital color Doppler imaging (CDI) and ophthalmological findings. Case: A 47-year-old man suffered from lumbar pain and low-grade fever. He had undergone heart surgery for a ventricular septal defect and received blood transfusions 20 years earlier, and he had started interferon therapy for chronic hepatitis C 8 months previously. Systemic examinations suggested either collagen disease, malignant lymphoma, or infectious disease. Observations: The patient underwent a complete ophthalmological examination, including CDI. Ophthalmoscopy showed multiple cotton-wool patches in both eyes and branch retinal artery occlusion in the left eye. Orbital CDI showed that bilateral ophthalmic arteries and central retinal arteries flowed synchronously with abnormal waves composed of three narrow, sharp peaks. These findings were suggestive of a cardiac valve disorder, which can lead to embolisms. Echocardiography established the diagnosis of infectious endocarditis. Conclusions: To the best of our knowledge, this is the first reported case of infectious endocarditis detected by orbital CDI. (C) Japanese Ophthalmological Society 2005.