Abstract
Purpose. To report a rare presentation of culture positive Mycobacterium chelonae (M. chelonae) corneal ulcer and its management. Case Report. We report a rare case with history of chronic pain and blurriness of vision. Examination revealed chronic nonhealing paracentral corneal ulcer inferiorly at 5 to 7 o'clock meridian with anterior chamber cells 1+ unresponsive to routine antibiotic and antifungal medications with Mantoux test (MT) positivity in a middle aged nondiabetic patient with no prior obvious history of trauma, ocular surgery, and contact lens usage. Discussion. Ziehl Neelsen (ZN) staining in nonhealing ulcer revealed acid fast bacilli typical of M. chelonae with subsequent culture positivity in Lowenstein Jensen (LJ) medium. Subsequent treatment with topical fortified amikacin and tobramycin resulted in rapid healing of corneal ulcer. Conclusion. M. chelonae presenting as a chronic nonhealing corneal ulcer spontaneously occurring in a healthy young adult with no predisposing factor draws the need to have a good index of suspicion by performing ZN stain and culture and its subsequent successful management with topical fortified amikacin and tobramycin.
Highlights
The nontuberculous Mycobacterium chelonae (M. chelonae) is an omnipresent saprophyte present in soil, water, and air [1]
Occurring M. chelonae infection presenting as a nonhealing corneal ulcer in a healthy young adult with no predisposing factor has not been reported till date
Girgis et al in their retrospective study of ocular infections caused by nontuberculous mycobacteria reported 36.6% incidence of keratitis most commonly caused by M. abscessus/chelonae with identifiable risk factors being presence of biomaterials (63.1%), ocular surgery (24.1%), and steroid exposure (77%) [8]
Summary
The nontuberculous Mycobacterium chelonae (M. chelonae) is an omnipresent saprophyte present in soil, water, and air [1]. Breakdown of the corneal epithelium due to surgical trauma increases the risk of surface infection and increases the virulence of these rapidly growing mycobacteria [4]. Nocardia and atypical mycobacteria like M. chelonae and M. fortuitum and scrofuloderma have been identified as uncommon infective causes of chronic nonhealing corneal ulcers [5]. A history of trauma with foreign body (usually metallic), prior ocular surgery, or contact lens usage is usually present in such cases [6]. Local iatrogenic insult or systemic immunosuppression has been identified as the most common cause of nontuberculous mycobacterial associated ocular infections [6]. We report a very rare case of nonhealing corneal ulcer with Ziehl Neelsen (ZN) stain and culture positivity for M. chelonae and describe its management
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