Fulminant Bilateral Streptococcus pneumoniae Endophthalmitis in a Kidney Transplant Patient With Prior Herpetic Keratopathy

Streptococcus pneumoniae endophthalmitis is an uncommon but highly aggressive intraocular infection, particularly in immunocompromised patients. Rapid clinical deterioration with irreversible visual loss and systemic complications is frequent. This report describes a fatal case of bilateral pneumococcal endophthalmitis in a kidney transplant recipient with chronic herpetic keratopathy. A 58-year-old woman with stable renal graft function and a history of recurrent herpetic keratitis underwent left corneal transplantation. Fifty days postoperatively, she presented with worsening ocular pain and visual loss. Microbiological cultures obtained from corneal scrapings and vitreous aspirate revealed Streptococcus pneumonia. Intravenous and intravitreal broad-spectrum antibiotics were initiated, and retransplantation of the left cornea was performed. Despite timely intervention, the patient developed acute kidney injury, suspected herpetic meningoencephalitis, and septic shock, ultimately progressing to multiorgan failure and death. This case highlights the fulminant nature of pneumococcal endophthalmitis in immunosuppressed patients and underscores the importance of early microbiologic diagnosis, multidisciplinary management, and tailored immunosuppressive adjustment.