Amikacin-resistant atypical mycobacterial keratitis

Here, we report a novel case of amikacin-resistant atypical mycobacterial keratitis in a man in his third decade. He presented with gradual diminution of vision associated with pain, redness, watering in his left eye of 1½ months' duration, with a characteristic cracked windshield appearance of corneal ulcer. Smear as well as culture showed the presence of atypical mycobacterial species. Based on clinical and microbiological results, 1% amikacin sulfate eye drops was started. However, the subsequent sensitivity report revealed resistance to amikacin. Following this, other broad-spectrum antibiotics were tested in a microbiology laboratory to find an alternative drug and the organism was found sensitive to gentamicin. The patient responded well to fortified gentamicin eye drops.Gentamicin is not routinely used for the treatment of atypical mycobacterial keratitis. However, in cases resistant to amikacin, other broad-spectrum antibiotics should be tested to determine an alternative and suitable antimicrobial drug.