Metagenomic next-generation sequencing of aqueous humor guides targeted therapy for Staphylococcus epidermidis endophthalmitis in chronic ocular graft-versus-host disease: a case report
- 1Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital
- 2Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University
- 3Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology
Abstract
Purpose: To report a case of Staphylococcus epidermidis endophthalmitis in chronic ocular graft-versus-host disease, refractory to empirical broad-spectrum antibiotics, rapidly identified by metagenomic next-generation sequencing of aqueous humor, and successfully managed with targeted vancomycin without vitrectomy.
Methods: Case report.
Results: A 35-year-old male with chronic oGVHD following allo-HSCT for acute myeloid leukemia developed endophthalmitis after 10 months of progressive disease. Slit-lamp examination revealed central corneal ulceration (4 × 2 mm) with hypopyon (1 mm). B-scan ultrasonography confirmed mild vitreous haze. Conventional microbiological workup of aqueous humor—including Gram stain, potassium hydroxide (KOH) mount, and bacterial/fungal culture—yielded negative results. Aqueous humor mNGS detected 5,543 unique reads of S. epidermidis (genome coverage 12.3%, no co-pathogens), exceeding the clinical significance threshold. Based on this result, therapy was switched to targeted intracameral and periocular vancomycin (10 mg/ml) combined with intravenous vancomycin (0.5 g twice daily). Vancomycin was selected for its reliable Gram-positive coverage, including coagulase-negative staphylococci , referencing the established intravitreal dose of 1 mg/0.1 mL. The infection was controlled without corneal perforation or vitrectomy. AMT was performed for persistent epithelial defects. At 1.5 years follow-up, anatomical preservation was maintained (BCVA 20/400 OD; 20/40 OS).
Conclusion: In immunosuppressed oGVHD patients with suspected endophthalmitis, aqueous humor mNGS overcomes the diagnostic limitations of conventional culture and guides a timely switch from empirical antibiotics to targeted therapy, achieving infection control and anatomical preservation without invasive vitrectomy or enucleation.
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BibTeX
@article{wang2026metagenomic,
title = {{Metagenomic next-generation sequencing of aqueous humor guides targeted therapy for Staphylococcus epidermidis endophthalmitis in chronic ocular graft-versus-host disease: a case report}},
author = {Jingjing Wang and Junyu Hu and Xing Liang and Fang Yuan and Lijuan Ren and Tao Wang and Zhilin Gao and Yajian Duan},
journal = {Frontiers in Immunology},
year = {2026},
month = oct,
doi = {10.3389/fimmu.2026.1966692},
url = {https://www.frontiersin.org/articles/10.3389/fimmu.2026.1966692/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Metagenomic next-generation sequencing of aqueous humor guides targeted therapy for Staphylococcus epidermidis endophthalmitis in chronic ocular graft-versus-host disease: a case report
AU - Jingjing Wang
AU - Junyu Hu
AU - Xing Liang
AU - Fang Yuan
AU - Lijuan Ren
AU - Tao Wang
AU - Zhilin Gao
AU - Yajian Duan
PY - 2026
DA - 2026/10/19
JO - Frontiers in Immunology
DO - 10.3389/fimmu.2026.1966692
UR - https://www.frontiersin.org/articles/10.3389/fimmu.2026.1966692/full
AB - Purpose: To report a case of Staphylococcus epidermidis endophthalmitis in chronic ocular graft-versus-host disease, refractory to empirical broad-spectrum antibiotics, rapidly identified by metagenomic next-generation sequencing of aqueous humor, and successfully managed with targeted vancomycin without vitrectomy. Methods: Case report. Results: A 35-year-old male with chronic oGVHD following allo-HSCT for acute myeloid leukemia developed endophthalmitis after 10 months of progressive disease. Slit-lamp examination revealed central corneal ulceration (4 × 2 mm) with hypopyon (1 mm). B-scan ultrasonography confirmed mild vitreous haze. Conventional microbiological workup of aqueous humor—including Gram stain, potassium hydroxide (KOH) mount, and bacterial/fungal culture—yielded negative results. Aqueous humor mNGS detected 5,543 unique reads of S. epidermidis (genome coverage 12.3%, no co-pathogens), exceeding the clinical significance threshold. Based on this result, therapy was switched to targeted intracameral and periocular vancomycin (10 mg/ml) combined with intravenous vancomycin (0.5 g twice daily). Vancomycin was selected for its reliable Gram-positive coverage, including coagulase-negative staphylococci , referencing the established intravitreal dose of 1 mg/0.1 mL. The infection was controlled without corneal perforation or vitrectomy. AMT was performed for persistent epithelial defects. At 1.5 years follow-up, anatomical preservation was maintained (BCVA 20/400 OD; 20/40 OS). Conclusion: In immunosuppressed oGVHD patients with suspected endophthalmitis, aqueous humor mNGS overcomes the diagnostic limitations of conventional culture and guides a timely switch from empirical antibiotics to targeted therapy, achieving infection control and anatomical preservation without invasive vitrectomy or enucleation.
SN - 1664-3224
ER -