Diagnostics and Treatment of Polymicrobial Keratitis and Endophthalmitis?Case Report

Abstract

Purpose: To describe a case of polymicrobial keratitis and endophthalmitis successfully treated with topical and systemic antibacterial and antifungal agents, collagen cross-linking (CXL) and penetrating keratoplasty. Methods: Case report Results: A 59-year-old woman presented with a corneal ulcer. Multiple samplings of the corneal lesion were used for microbiological investigations by standard protocol that repeatedly revealed coagulase-negative Staphylococcus sp. (CoNS); mycotic tests were negative. She was treated with topical and systemic antibiotics and an emergency therapeutic keratoplasty was performed. Four months later, she was readmitted for ulcerative keratitis and endophthalmitis. Laboratory work up on corneal corneal scraping and aqueous humor cultures showed a Fusarium species, CoNS and Bacillus species. She was treated with topical and systemic voriconazole, antibacterials, and the corneal cross-linking (CXL) procedure. Complete resolution of the infection was observed but a large vascular leucoma developed. A penetrating keratoplasty and anterior segment reconstruction surgery with very good results were performed seven months later. Conclusions: Voriconazole, antibacterial antibiotics and CXL were effective in the management of a severe polymicrobial corneal ulcer progressing to endophthalmitis with no side-effects observed.