Infectious Crystalline Keratopathy Caused by Klebsiella

Oxytoca

Rohit Adyanthaya, MD, Timothy Chou, MD,

Lorena LoVerde, BS.

SUNY Eye Institute, Stony Brook University, NYThe authors have no financial interests to disclose.

Purpose

To report a novel case of a Klebsiella oxytoca infectious crystalline keratopathy

Background• Infectious crystalline keratopathy (ICK) is a

slowly progressing corneal infection characterized by branching, grayish-white, needle-like opacities within the corneal stroma, with a paucity of corneal and anterior segment inflammation.

• Risk factors for infectious crystalline keratopathy include previous corneal surgery, long-term topical corticosteroid use, and prior corneal disease.

Background

• Many organisms have been identified as causative agents in ICK. Gram positive alpha hemolytic streptococci, typically of the Viridans group, are the most common pathogens encountered.

• Gram negative organisms have also been implicated in ICK, on occasion, such as Pseudomonas and Serratia marcescens.

Methods

Retrospective case report. Medical records were reviewed for past ocular and medical history.

Findings

CASE REPORT: An 80-year-old woman presented with complaint of a white spot in the left eye for the past two to three days. The patient noticed mild soreness and discharge. She had a complicated past ocular history including a failed penetrating keratoplasty. At the time of presentation she was being maintained on prednisolone acetate 1%, twice per day.

Findings

• CASE REPORT (continued): There was an extensive stromal ulcer and infiltrate in the transplant involving much of its inferior and central aspects, bordered by the graft edge. Extending upward from the infiltrate into the superonasal graft were branching, needle-like deep stromal opacities (see figure in next slide).

Slit lamp photograph of infectious keratitis in the graft. Arrow points to branching needle-like pattern of infiltrate.

Results• Corneal scrapings demonstrated Gram-

negative bacilli. The organism was identified as Klebsiella oxytoca on culture.

• The patient was placed on double antibiotic therapy with hourly moxifloxacin* 0.3% and fortified tobramycin 15 mg/ml. After 2 months of treatment, there was gradual resolution of the infection, with healing of the ulcer and scarring of the infiltrate.

*Moxifloxacin eyedrops for keratitis is an off-label use of the drug

Conclusions• This is the first reported case of Klebsiella oxytoca

as a cause of infectious crystalline keratopathy.• Eradication of the infection required prolonged

treatment with double topical antibiotic therapy.• More study may be required to determine if this

approach results in faster resolution than monotherapy, or reduces the need for surgical intervention.

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