Iris root abscess and necrotizing sclerokeratitis caused by Mycobacterium abscessus and presenting as hemorrhagic...

To report a case of an iris abscess and necrotizing sclerokeratitis caused by Mycobacterium abscessus and presenting as hemorrhagic uveitis.

An 86-year-old white woman was diagnosed with hemorrhagic anterior uveitis and treated with high-frequency topical steroids. The inflammation progressed to involve the cornea and the sclera, and the treatment was changed to intensive antibiotics. There was no improvement. Direct microscopy of a biopsy specimen of the lesion wrongly identified Nocardia as the cause, but antibiotic sensitivity suggested clarithromycin as a suitable therapeutic agent. Therapy was changed but there was continued deterioration. The eye could not be saved and the causative organism was subsequently discovered to be M. abscessus.

The eye was enucleated 6 months after initial presentation.

Ocular infection with M. abscessus is an extremely rare cause of necrotizing sclerokeratitis and may present as a hemorrhagic uveitis. There is a high risk of misdiagnosis and late detection, which may have severe consequences.