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Published on: September 17, 2014
Post-Keratoplasty Infectious Keratitis Caused by Elizabethkingia meningoseptica
Albaraa Alfaraidi1,2, Mohammed Alshehri1, Lamia Alhijji1
1Anterior Segment Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia.
Abstract:
BACKGROUND Microbial keratitis is a major complication of keratoplasty that is associated with serious ocular sequalae if not adequately treated. The purpose of this case report is to present a case of infectious keratitis following keratoplasty caused by the rare microorganism Elizabethkingia meningoseptica. CASE REPORT A 73-year-old patient presented to the outpatient clinic complaining of a sudden decrease of vision in his left eye. The right eye was enucleated during childhood due to ocular trauma and an ocular prosthesis was placed in the orbital socket. He underwent penetrating keratoplasty 30 years ago for corneal scar and repeated optical penetrating keratoplasty for failed graft in 2016. He was diagnosed with microbial keratitis following optical penetrating keratoplasty in the left eye. Corneal scraping of the infiltrate showed growth of the gram-negative bacteria Elizabethkingia meningoseptica. Conjunctival swab of the orbital socket of the fellow eye was positive for the same microorganism. E. meningoseptica is a rare gram-negative bacterium, which is not part of the normal ocular flora. The patient was admitted for close monitoring and was started on antibiotics. He showed significant improvement after treatment with topical moxifloxacin and topical steroids. CONCLUSIONS Microbial keratitis is a serious complication following penetrating keratoplasty. An infected orbital socket could be a risk factor of microbial keratitis of the fellow eye. A high index of suspicion, along with timely diagnosis and management, may improve the outcome and clinical response and reduce the morbidity associated with these infections. Prevention of infectious keratitis is essential and may be achieved by optimizing the ocular surface and treating the risk factors for infection.
Insights
This case report details Elizabethkingia meningoseptica causing microbial keratitis after keratoplasty. An infected orbital socket may pose a risk to the fellow eye, highlighting the need for vigilant diagnosis and management.
Area of Science:
- Ophthalmology
- Microbiology
Background:
- Microbial keratitis is a significant complication following keratoplasty (corneal transplant).
- Prompt and adequate treatment is crucial to prevent severe ocular sequelae.
Observation:
- A 73-year-old patient developed microbial keratitis in the left eye post-penetrating keratoplasty.
- Corneal scrapings identified the rare gram-negative bacterium Elizabethkingia meningoseptica.
- The same microorganism was detected in the conjunctival swab of the patient's fellow eye's orbital socket.
Findings:
- Elizabethkingia meningoseptica, a rare bacterium not part of normal ocular flora, was the causative agent.
- The patient responded well to topical moxifloxacin and topical steroids.
- An infected orbital socket may serve as a potential risk factor for microbial keratitis in the contralateral eye.
Implications:
- This case underscores the importance of a high index of suspicion for diagnosing rare microbial keratitis post-keratoplasty.
- Timely diagnosis and management are essential for improving clinical outcomes and reducing morbidity.
- Preventive strategies should focus on optimizing the ocular surface and managing infection risk factors.
