Posters

An unusual cause of severe corneal ulceration in a non-contact lens wearer: Moraxella osloensis keratitis

Poster Details

First Author: A.Ceausescu SPAIN

Co Author(s):    M. Martinez Hergueta   N. Doménech Aracil   J. Pérez Santonja              

Abstract Details

Purpose:

To describe the management of severe Moraxella osloensis infectious keratitis in a non-contact lens wearer. Moraxella osloensis is an aerobic, oxidase-positive, gram-negative coccobacillus and it is part of the human flora, especially the upper respiratory tract and occasionally of the skin and urogenital tract. There are few reported ocular infections caused by M. osloensis.

Setting:

Department of Ophthalmology. Hospital General Universitario de Alicante. Alicante. Spain

Methods:

A 64-year-old woman was referred to our emergency department with a 4-day history of pain, redness and decreased vision in her right eye. Her best-corrected visual acuity was hand movements in the right eye and 20/20 in the left eye. Slit-lamp exam of her right eye revealed a ciliary injection, corneal ulcer with extensive stromal suppurative infiltration and hypopyon. The left eye examination was unremarkable. Intraocular pressure was 14 mm Hg in both eyes. Corneal ulcer scraping was performed and topical treatment was started with fortified ceftazidime and tobramycin every hour.

Results:

The culture results revealed Moraxella osloensis. After five days of intensive treatment the clinical features worsened with an increase in epithelial defect, more hypopyon and the appearance of a double ring infiltrate. Due to the progressive worsening of the corneal ulcer, despite intensive topical antimicrobial therapy, the patient underwent a corneal biopsy with negative microbiological and histopathological results. After shifting the medical regimen to ceftazidime and linezolid, the keratitis was controlled. Five months after her first visit, the patient presented an extensive corneal leukoma with mild corneal thinning and her best corrected visual acuity has improved to 20/200.

Conclusions:

Corneal biopsy is an important diagnostic tool especially in the management of patients with progressive microbial keratitis, despite antimicrobial therapy. This case highlights the importance of making a rapid diagnosis and setting the proper treatment with topical fortified antibiotic combinations for Moraxella osloensis keratitis in a non-contact lens wearer, manifesting as an ulcerative double ring infiltrate. Ring-shaped corneal infections have been classically associated with Acanthamoeba, but now have been observed with a number of other microorganisms or immunological process like Wessely rings.

Financial Disclosure:

None