Topic outline

  • Grand Rounds

    A 39-year-old Hispanic male presented to the Emergency Room with worsening blurry vision and pain in the left eye for 1 month after feeling something “fly into his eye” while cutting wood. Visual acuity was 20/40 on presentation with a small 1 x 1 mm multifocal anterior stromal corneal infiltrate. After multiple rounds of corneal cultures, initial corneal biopsy grew Staphylococcus aureus. The patient was treated with broad-spectrum antibiotic drops for 3 weeks with progressive worsening. He was lost to follow up for 7 months though had been treated with tobramycin-dexamethasone drops in the interim for 4 months. He presented again to the Emergency Room with count fingers visual acuity and a large 7 x 7 mm corneal ulcer extending to the superior limbus. Initial corneal cultures grew Staphyloccocus epidermidis, but the patient continued to worsen on topical antibiotic and antifungal therapy and had a corneal perforation after 1 week. He underwent therapeutic penetrating keratoplasty, with cultures growing Mycobacterium spp. resulting 2 weeks later. The patient was treated with combination topical moxifloxacin and amikacin drops for 3 months postoperatively. Final cultures speciated Mycobacterium kansasii (sensitive to both antibiotics), with no recurrence of infection noted within the corneal transplant at last follow-up visit (3 months postoperatively) although the graft has chronic failure.

    Presentation Date: 02/06/2020
    Issue Date: 08/01/2020