The mortality rate of bacterial meningitis in adults has markedly decreased to 20%. This destructive disease could result in various sequela including hearing loss and impaired cognitive function, sometimes with the impediment to rehabilitation into society 1)-3) . Endogenous endophthalmitis accompanied by bacterial meningitis is an extremely rare condition that must be immediately detected and treated properly because of the risks of severe visual impairment. We report a rare case of an

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... -old woman with bacterial meningitis complicated by bilateral endogenous endophthalmitis. In August 2017, an 82-year-old woman, who showed no impairment in activities of daily living without external support, developed a 39°C fever in the evening after she had worked outside in the yard that morning. The medical history of the patient included bilateral cataract, treated surgically in 2012 following vitrectomy in the right eye because of infection; there had been no growth in the vitreous culture. The patient was brought to our hospital; however, she was diagnosed with heat illness upon physical examination. The following day, she returned to our hospital by ambulance with a disturbance in consciousness and 40°C fever. A blood test showed a normal leukocyte count (7,900/μl; normal range 3,000-7,000/μl) and an elevation of C-reactive protein (6.5 mg/dl; normal range 0-0.5 mg/dl); urine test revealed pyuria, and blood and urine cultures were taken for microbiological examination. With these data, she was diagnosed with urinary tract infection and administered 2 g of ceftriaxone. On the second day after admission, although her temperature had lowered, she reported neck stiffness; she was then examined by our team. In our physical examination, the patient lacked readiness to answer questions due to confusion and showed neck stiffness without any other neurological findings. She exhibited tachycardia with a heart rate of 96 beats/min, fever (40.3°C), slightly high blood pressure (141/68 mmHg), and an oxygen saturation of 92% on room air. Lumbar puncture was performed; cerebrospinal fluid (CSF) analysis showed normal cerebrospinal pressure (95 mmH 2 O; normal range 50-180 mmH 2 O), an elevated leukocyte count (1,056/μl; normal range 0-5/μl), mononuclear cell 251/μl, multinucleated cell 805/μl, an elevated protein level (95 mg/dl; normal range 15-45 mg/dl), and a normal glucose level (59 mg/dl; corresponding blood glucose level 148 mg/dl). Blood culture detected methicillin-susceptible Staphylococcus aureus (MSSA) and CSF culture was negative. Thoracicoabdominal CT scan did not show any signs of infectious focus. Brain diffusion-weighted MRI showed multiple small high signal debris in the limbic cortex and the limbic cere bellum suggesting acute secondary cerebral Endogenous endophthalmitis is a rare complication of acute meningitis. A healthy 82-year-old woman suddenly developed septic bacteremia and meningitis owing to Staphylococcus aureus (methicillin-susceptible Staphylococcus aureus); she presented with a high fever and drowsiness. Improvement of these initial symptoms unveiled impaired bilateral visual acuity. Detailed ophthalmological assessments diagnosed it as probable endogenous endophthalmitis, which was immediately treated with vitrectomy. Subsequently, the patient totally recovered without any neurologic or ophthalmic sequela. endophthalmitis, Staphylococcus aureus, bacterial meningitis