Non-tuberculous mycobacteria related infectious crystalline keratopathy

Umapathy, T; Singh, Ranveer; Dua, Harminder S; Donald, Fiona

doi:10.1136/bjo.2005.069856

Cited by 13 publications

(6 citation statements)

References 6 publications

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“… 2 , 3 Breakdown of the corneal epithelium due to surgical trauma increases the risk of surface infection and increases the virulence of these rapidly growing mycobacteria. 4 Nonhealing corneal ulcers unresponsive to routine antibacterial and antifungal agents but with normal corneal sensations are usually associated with underlying diabetes mellitus and systemic immunocompromised states. Nocardia and atypical mycobacteria like M. chelonae and M. fortuitum , and scrofuloderma have been identified as uncommon infective causes of chronic nonhealing corneal ulcers.…”

Section: Introductionmentioning

confidence: 99%

An unusual case of spontaneous Mycobacterium chelonae corneal ulcer in a healthy middle-aged adult

Bhandari

Sriganesh

Relekar

2016

IMCRJ

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BackgroundTo report a rare presentation of culture-positive Mycobacterium chelonae corneal ulcer and its management.FindingsWe report a rare case of a patient with a history of chronic pain and blurriness of vision. Examination revealed a chronic nonhealing paracentral corneal ulcer inferiorly at the 5–7 o’clock meridian with anterior chamber reaction unresponsive to routine antibiotic and antifungal medications with Mantoux test positivity in a middle-aged nondiabetic patient with no prior history of trauma, ocular surgery, and contact lens usage. Ziehl–Neelsen staining of the nonhealing ulcer revealed acid-fast bacilli typical of M. chelonae, with subsequent culture positivity in Löwenstein–Jensen medium. Subsequent treatment with topical fortified amikacin and tobramycin resulted in rapid healing of the corneal ulcer.ConclusionM. chelonae presenting as a chronic nonhealing corneal ulcer spontaneously occurring in a healthy adult with no predisposing factor draws attention towards the need to have a good index of suspicion by performing a Ziehl–Neelsen stain and culture, and subsequent successful management with topical fortified amikacin and tobramycin.

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Section: Introductionmentioning

confidence: 99%

An unusual case of spontaneous Mycobacterium chelonae corneal ulcer in a healthy middle-aged adult

Bhandari

Sriganesh

Relekar

2016

IMCRJ

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“…laser refractive surgery) or breakdown of the corneal epithelium increases the risk of surface infection. [3,4]. In our patient, the most likely source of bilateral keratitis was from cross contamination of her contact lens solution.…”

Section: Discussionmentioning

confidence: 67%

An unusual case of Mycobacterium chelonae in contact lens solution

Jeganathan¹,

Tariq²,

Koay³

2016

New Front Ophthalmol

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Importance: Microbial keratitis is an increasing complication amongst contact lens wearers. In the absence of positive cultures, there should be a high index of suspicion for uncommon pathogens including acanthamoeba, herpes simplex, fungi and mycobacteria. Our unique case highlights mycobacteria as serious a pathogen which requires aggressive therapy. Successful treatment of mycobacteria could result in good visual potential. Observations:We describe an original case of presumed Mycobacterium chelonae infection and management in an elderly contact lens wearer with a protracted clinical course of bilateral non-healing epithelial defects. The patient initially did not reveal she was a contact lens wearer. She later confessed to washing contact lens with domestic tap water, but later changed this practice by using a contact lens disinfecting solution. Inspection of her contact lens solution revealed expiry 3 years earlier, from which Mycobacterium chelonae was eventually isolated. Resolution of her keratitis only occured after triple antibiotic therapy of topical amikacin, moxifloxacin and azithromycin supported by oral clarithromycin. She later underwent penetrating keratoplasty in both eyes, with good visual outcome. Conclusions and relevance:To the best of our knowledge, this is the first reported case of bilateral Mycobacterium chelonae keratitis arising from contaminated CL solution. This case illustrates the importance of considering Mycobacterium in the differential diagnoses when treating non healing keratitis. It is important to enquire about contact lens wear and hygiene in all keratitis cases, regardless of patient age. There is a need to create public awareness regarding the potential serious risk of CL wear and safe CL practice that includes monitoring by eye care professionals.

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“…To date, 9 cases of ICK secondary to nontuberculous mycobacteria have been published, with most reported cases associated with previous corneal surgery including the first two cases published in 1986 after radial keratectomy, 3 cases after LASIK surgery, and 1 case each reported after cataract extraction and penetrating keratoplasty. [3][4][5][6] In 8 of these 9 reported cases, M. chelonae was the causative organism, although contamination sources were rarely definitively identified. 9 All eyes were treated with topical antibiotics, 3 individuals were treated with oral clarithromycin, and 3 eyes required therapeutic penetrating keratoplasty.…”

Section: Discussionmentioning

confidence: 99%

Infectious Crystalline Keratopathy Secondary to Mycobacterium chelonae

Bonnet

Onishi

Aldave

2022

Cornea

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Purpose:The aim of this study was to describe the clinical presentation and multimodal imaging of a patient diagnosed with infectious crystalline keratitis (ICK) secondary to Mycobacterium chelonae.Methods:This is a case report of a patient with a crystalline corneal infiltrate imaged with anterior segment optical coherence tomography and in vivo scanning laser confocal microscopy. Bacterial, fungal, acanthamoeba, and acid-fast cultures were performed to identify the causal pathogen.Results:Examination revealed a white stellate opacity in the midstroma underlying the scalloped border of an area of central corneal stromal thinning, consistent with a diagnosis of ICK. Anterior segment optical coherence tomography demonstrated a hyperreflective diamond-shaped opacity located at a depth of 334 μm, which demonstrated multiple stellate projections on in vivo scanning laser confocal microscopy. The acid-fast culture was positive for Mycobacterium chelonae.Conclusions:Although ICK is most commonly associated with Streptococcus species, it may be secondary to atypical bacteria including Mycobacterium species, underscoring the importance of diagnostic imaging and collecting corneal cultures to identify the pathogenic organism.

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Non-tuberculous mycobacteria related infectious crystalline keratopathy

Cited by 13 publications

References 6 publications

An unusual case of spontaneous Mycobacterium chelonae corneal ulcer in a healthy middle-aged adult

An unusual case of spontaneous Mycobacterium chelonae corneal ulcer in a healthy middle-aged adult

An unusual case of Mycobacterium chelonae in contact lens solution

Infectious Crystalline Keratopathy Secondary to Mycobacterium chelonae

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