Corneal Infection by Enterobacter Cloacae post Penetrating Keratoplasty

Abstract

A 50-year-old woman underwent Penetrating Keratoplasty (PK) for Adherent Leukoma in her left eye. Three months later she reported with complaints of decrease in visual acuity, pain, redness and photophobia. She was given pulsed intravenous (IV) methyl prednisolone. There was reduction in symptoms however visual acuity did not improve. Ocular examination revealed visual acuity of 6/6 unaided in right eye and HMCF (Hand movements close to face) with accurate PR (Projection of rays).She developed a central corneal ulceration. Scraping of the corneal lesion revealed Gram-negative bacilli. Genus level identification was achieved using standard techniques and species level identification, revealing Enterobacter Cloacae, was aided by a VITEK 2 compact system. Broad-spectrum fortified antibiotics were initially started followed by species-sensitive fortified antibiotics. This case report, for the first time, highlights Enterobacter Cloacaeas a cause of an aetiological agent of corneal ulcer following PK. Members of the genus Enterobacter are commensal organisms of the gastrointestinal tract and are considered pathogenic only for patients with lowered resistance to infection (e.g., chronic infection, cancer, or diabetes mellitus) or those with impaired immunity (congenital, acquired, or impaired immunity secondary to therapy). This organism has been implicated in endophthalmitis cases in previous case reports. However, to the best of our knowledge corneal infection caused by this organism has not been reported sofar.