Purpose: To present a case of unusual corneal infection early in the course of peripheral ulcerative keratitis in a patient with severe vitamin A deficiency. Method: Single observational case report in urban USA. Case Presentation: An alcoholic patient with pancreatitis, chronic diarrhea, and vitamin A deficiency presented with a marginal corneal ulcer from which two bacteria of the family Micrococcaceae were cultured and identified by genome sequence analysis, namely Kocuria palustris and Rothia mucilaginosa. Soon after, severe bilateral peripheral ulcerative keratitis developed, later accompanied by eyelid cellulitis of one lid. These conditions improved with antibiotics, treatment of the underlying gastrointestinal conditions, and treatment of the vitamin deficiency. Conclusion: Susceptibility to keratitis with unusual bacteria of the Micrococcaceae family can occur in the setting of alcoholism-related gastrointestinal disease with severe vitamin A deficiency. To our knowledge, K. palustris is a species not previously identified in any human disease, and the Kocuria genus has not previously been reported as a participant in eye infection. Documented cases of R. mucilaginosa in ocular disease are rare. These unusual infections heralded the onset of severe marginal corneal melts.
Locke often writes that our knowledge is the perception of the agreement or disagreement of ideas. For example, he refers to “our Knowledge consisting in the perception of the Agreement, or Disagreement of any two Ideas” in the second chapter of the Essay's book on knowledge (4.2.15). Similarly, at the beginning of this book he characterizes knowledge as “the perception of the connexion and agreement, or disagreement and repugnancy of any of our Ideas” (4.1.2). Since commentators remark on this formula so frequently, one would expect that major questions about its interpretation would have been settled long ago. But not so. Controversy still prevails about Locke's intent, and especially about his assumption that the knowledge of the existence of real things counts as an instance of the perception of the agreement or disagreement of ideas (4.1.3,7).Scholars have put forward two sorts of problems about the attempted assimilation of knowledge of real existence to Locke's formula.
PurposeTo present a case of peripheral ulcerative keratitis with perforation in the setting of syphilis.MethodA single observational case report in urban USA.Case PresentationA patient with multiple sexual partners presented with bilateral peripheral ulcerative keratitis, unilateral corneal perforation, and a pustular rash. Workup was positive for syphilis as well as HSV, HIV, and multiple autoantibody tests. Findings improved after treatment for syphilis.ConclusionBilateral peripheral ulcerative keratitis in syphilis has been reported in one prior case. However, corneal perforation in the setting of syphilis infection has not, to our knowledge, been reported previously.
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