Mycobacterium haemophilum necrotising keratitis in a cornea with no prior surgical intervention

A well-managed hypertensive and dyslipidaemic female in her 60s presented with a 4 month history of progressive visual decline, ocular irritation and localised erythema in her right eye. These ocular symptoms were associated with repeated exposure to environmental water sources. Clinical evaluation revealed marked conjunctival injection, corneal oedema, diffuse stromal haze and a dense infiltrate with a 6×6 mm epithelial defect at the central cornea. A penetrating keratoplasty revealed acid-fast bacilli in the corneal pathology, confirmed as Mycobacterium haemophilum via the line probe assay. Mycobacterial growth was absent in culture.A comprehensive treatment regimen, including systemic amikacin, levofloxacin, rifampicin, azithromycin and topical antituberculous therapy, resulted in significant clinical improvement. This case highlights M. haemophilum as an infrequent cause of non-tuberculous mycobacterial keratitis. Recurrent eye contact with contaminated water was shown as a notable risk factor in the absence of prior corneal interventions.