Asymptomatic Endogenous Endophthalmitis in a Preterm Neonate with Burkholderia cepacia Sepsis: A Rare Incidental Detection

Endogenous endophthalmitis is a rare, vision-threatening intraocular infection resulting from hematogenous dissemination of pathogens, with diagnosis in neonates often delayed due to minimal or absent external ocular signs. Burkholderia cepacia, a multidrug-resistant non-fermenting Gram-negative bacillus, is an exceedingly rare cause of ocular infection in neonates. We report a 35-week preterm male neonate with respiratory distress and low birth weight who developed late-onset sepsis with blood culture positive for Burkholderia cepacia. During routine retinopathy of prematurity screening, the right eye demonstrated hazy vitreous media without conjunctival congestion, chemosis, or hypopyon. B-scan ultrasonography revealed lateral choroidal detachment consistent with endogenous endophthalmitis, while TORCH screening was negative. Despite systemic antibiotic therapy, persistent ocular involvement necessitated vitreous tap with intravitreal vancomycin and ceftazidime administration; however, vitreous cultures remained sterile. Given the limited therapeutic response, intravenous corticosteroids were administered, but vitreous opacity and detachment persisted, leading to recommendation for pars plana vitrectomy. This case illustrates an unusual presentation of clinically silent endogenous endophthalmitis secondary to Burkholderia cepacia sepsis in a preterm infant. The complete absence of characteristic ocular symptoms emphasizes the critical importance of systematic ophthalmologic screening in septic premature neonates. Early identification through routine screening, prompt targeted antimicrobial therapy, and timely consideration of surgical intervention are paramount to preventing irreversible visual impairment in this vulnerable population. Heightened clinical suspicion and proactive ophthalmic evaluation should be standard practice in managing neonatal sepsis, particularly with unusual or resistant pathogens.