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Actinobacillus actinomycetemcomitans Keratitis After Glaucoma Infiltration Surgery

View Article: PubMed Central - PubMed

ABSTRACT

Actinobacillus actinomycetemcomitans infection is a rare and easily misdiagnosed ocular disease. In this article, the authors report a chronic, purulent, and difficult-to-treat case of A actinomycetemcomitans keratitis following a glaucoma infiltration surgery.

A 56-year-old man with a long-standing history of open-angle glaucoma in both eyes presented with a 12-week history of ocular pain, redness, and blurred vision in his right eye. He underwent a glaucoma infiltration surgery in his right eye 6 months ago. Three months postoperatively, he developed peripheral corneal stromal opacities associated with a white, thin, cystic bleb, and conjunctival injection. These opacities grew despite topical treatment with topical tobramycin, levofloxacin, natamycin, amikacin, and metronidazole eye drops.

Multiple corneal scrapings revealed no organisms, and no organisms grew on aerobic, anaerobic, fungal, or mycobacterial cultures. The patient's right eye developed a severe purulent corneal ulcer with a dense hypopyon and required a corneal transplantation. Histopathologic analysis and 16S ribosomalribonucleic acid polymerase chain reaction sequencing revealed A actinomycetemcomitans as the causative organism. Postoperatively, treatment was initiated with topical levofloxacin and cyclosporine, as well as oral levofloxacin and cyclosporine. Graft and host corneal transparency were maintained at the checkup 1 month after surgery.

Although it is a rare cause of corneal disease, A actinomycetemcomitans should be suspected in patients with keratitis refractory to topical antibiotic therapy. Delay in diagnosis and appropriate treatment can result in vision loss.

No MeSH data available.


Related in: MedlinePlus

Clinical slit lamp examination of Actinomyces keratitis at the initial visit (A), after 12-week antibiotics treatments (B), after 1-week course with a new antibiotics regimen (C), and 1 month after penetrating keratoplasty (D). Red arrows indicate peripheral corneal opacity, black arrows indicate satellite infiltrates, and blue arrows indicate anterior chamber hypopyon.
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Figure 1: Clinical slit lamp examination of Actinomyces keratitis at the initial visit (A), after 12-week antibiotics treatments (B), after 1-week course with a new antibiotics regimen (C), and 1 month after penetrating keratoplasty (D). Red arrows indicate peripheral corneal opacity, black arrows indicate satellite infiltrates, and blue arrows indicate anterior chamber hypopyon.

Mentions: A 56-year-old man without any ophthalmic or systemic diseases was referred to our cornea service with a 12-week history of ocular pain, redness, and blurred vision in his right eye. He was a government officer and had a long-standing history of open-angle glaucoma in both eyes. Six months ago, he underwent an uncomplicated glaucoma infiltration surgery on his right eye with an implantation by an EX-PRESS glaucoma filtration device. The best-corrected visual acuity (BCVA) of the right eye was 20/25 and 20/32 before and 1 month after surgery, respectively. Correspondingly, the intraocular pressure (IOP) was 28 and 15 mm Hg, respectively. Since then, he was followed-up monthly, with good control of his IOP in the right eye. Three months postoperatively, he developed peripheral corneal stromal opacities associated with a white, thin, cystic bleb, and conjunctival injection (Figure 1A). The cornea was clear; however, without any notable anterior chamber reaction was noted. The posterior segment examinations (including fundoscopy and ultrasound) were normal. His BCVA and IOP were 20/25 and 16 mm Hg, respectively. Thus, under the diagnosis of microbial keratitis, he received corneal scrapping for Gram stain and acid-fast stain. Aerobic, anaerobic, fungal, or mycobacterial cultures were performed, but no organisms were identified. Owing to his peripheral corneal opacity and conjunctival congestion, he was treated for bacterial keratitis. Topical eye drops, including 0.3% tobramycin and 0.5% levofloxacin, were applied hourly. After a 1-week course of antibiotics, the corneal and conjunctival signs had not resolved, so 0.5% natamycin eye drops 4 times per day was added for treating possible fungal keratitis. Unfortunately, the ocular conditions continued to worsen.


Actinobacillus actinomycetemcomitans Keratitis After Glaucoma Infiltration Surgery
Clinical slit lamp examination of Actinomyces keratitis at the initial visit (A), after 12-week antibiotics treatments (B), after 1-week course with a new antibiotics regimen (C), and 1 month after penetrating keratoplasty (D). Red arrows indicate peripheral corneal opacity, black arrows indicate satellite infiltrates, and blue arrows indicate anterior chamber hypopyon.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4998293&req=5

Figure 1: Clinical slit lamp examination of Actinomyces keratitis at the initial visit (A), after 12-week antibiotics treatments (B), after 1-week course with a new antibiotics regimen (C), and 1 month after penetrating keratoplasty (D). Red arrows indicate peripheral corneal opacity, black arrows indicate satellite infiltrates, and blue arrows indicate anterior chamber hypopyon.
Mentions: A 56-year-old man without any ophthalmic or systemic diseases was referred to our cornea service with a 12-week history of ocular pain, redness, and blurred vision in his right eye. He was a government officer and had a long-standing history of open-angle glaucoma in both eyes. Six months ago, he underwent an uncomplicated glaucoma infiltration surgery on his right eye with an implantation by an EX-PRESS glaucoma filtration device. The best-corrected visual acuity (BCVA) of the right eye was 20/25 and 20/32 before and 1 month after surgery, respectively. Correspondingly, the intraocular pressure (IOP) was 28 and 15 mm Hg, respectively. Since then, he was followed-up monthly, with good control of his IOP in the right eye. Three months postoperatively, he developed peripheral corneal stromal opacities associated with a white, thin, cystic bleb, and conjunctival injection (Figure 1A). The cornea was clear; however, without any notable anterior chamber reaction was noted. The posterior segment examinations (including fundoscopy and ultrasound) were normal. His BCVA and IOP were 20/25 and 16 mm Hg, respectively. Thus, under the diagnosis of microbial keratitis, he received corneal scrapping for Gram stain and acid-fast stain. Aerobic, anaerobic, fungal, or mycobacterial cultures were performed, but no organisms were identified. Owing to his peripheral corneal opacity and conjunctival congestion, he was treated for bacterial keratitis. Topical eye drops, including 0.3% tobramycin and 0.5% levofloxacin, were applied hourly. After a 1-week course of antibiotics, the corneal and conjunctival signs had not resolved, so 0.5% natamycin eye drops 4 times per day was added for treating possible fungal keratitis. Unfortunately, the ocular conditions continued to worsen.

View Article: PubMed Central - PubMed

ABSTRACT

Actinobacillus actinomycetemcomitans infection is a rare and easily misdiagnosed ocular disease. In this article, the authors report a chronic, purulent, and difficult-to-treat case of A actinomycetemcomitans keratitis following a glaucoma infiltration surgery.

A 56-year-old man with a long-standing history of open-angle glaucoma in both eyes presented with a 12-week history of ocular pain, redness, and blurred vision in his right eye. He underwent a glaucoma infiltration surgery in his right eye 6 months ago. Three months postoperatively, he developed peripheral corneal stromal opacities associated with a white, thin, cystic bleb, and conjunctival injection. These opacities grew despite topical treatment with topical tobramycin, levofloxacin, natamycin, amikacin, and metronidazole eye drops.

Multiple corneal scrapings revealed no organisms, and no organisms grew on aerobic, anaerobic, fungal, or mycobacterial cultures. The patient's right eye developed a severe purulent corneal ulcer with a dense hypopyon and required a corneal transplantation. Histopathologic analysis and 16S ribosomalribonucleic acid polymerase chain reaction sequencing revealed A actinomycetemcomitans as the causative organism. Postoperatively, treatment was initiated with topical levofloxacin and cyclosporine, as well as oral levofloxacin and cyclosporine. Graft and host corneal transparency were maintained at the checkup 1 month after surgery.

Although it is a rare cause of corneal disease, A actinomycetemcomitans should be suspected in patients with keratitis refractory to topical antibiotic therapy. Delay in diagnosis and appropriate treatment can result in vision loss.

No MeSH data available.


Related in: MedlinePlus