Infectious crystalline keratopathy associated with Klebsiella oxytoca

Timothy Y Chou,Rohit Adyanthaya

doi:10.1007/s12348-012-0071-0

Abstract

PurposeThe purpose of this study is to report a novel case of a Klebsiella oxytoca-associated infectious crystalline keratopathyMethodsThis is a case report study.Results An 80-year-old woman presented with complaint of noticing a white spot in the left eye for 2 to 3 days, as well as mild soreness and discharge. Past ocular history was notable for a failed left corneal transplant for which she was taking prednisolone acetate 1 % twice per day. On slit-lamp examination, there was an extensive stromal ulcer and infiltrate in the inferior half of the transplant. Extending superiorly in the graft were branching, needle-like deep stromal opacities, characteristic of infectious crystalline keratopathy. Diagnostic scrapings revealed Gram-negative bacilli, subsequently identified on culture as K. oxytoca. There was also light growth of Staphylococcus species. The patient was placed on double topical antibiotic therapy with moxifloxacin and fortified tobramycin. After 2 months of treatment there was gradual resolution of the infection.Conclusions K. oxytoca is a microorganism which can be associated with clinical infectious crystalline keratopathy, presenting as a mixed infection along with Staphylococcus species.

Highlights

Infectious crystalline keratopathy (ICK) is a slowly progressing corneal infection characterized by branching, grayishwhite, needle-like opacities within the corneal stroma, with a paucity of corneal and anterior segment inflammation [1, 2]
We present the first case of a patient with infectious crystalline keratopathy associated with Klebsiella oxytoca
Non-bacterial organisms have been implicated in ICK, like filamentous fungi and yeasts including Candida [2, 4, 8], and in mixed infections associated with Acanthamoeba [2, 9]

Summary

Introduction

Infectious crystalline keratopathy (ICK) is a slowly progressing corneal infection characterized by branching, grayishwhite, needle-like opacities within the corneal stroma, with a paucity of corneal and anterior segment inflammation [1, 2]. The bacteria are enveloped in a biofilm composed of an exopolysaccharide glycocalyx. This biofilm isolates the infectious organisms from the immune system, as well as conferring resistance to antimicrobial penetration [3]. Risk factors for infectious crystalline keratopathy include previous corneal surgery, long-term topical corticosteroid use, prior corneal disease, and systemic immunocompromise [2]. It has been reported after cataract extraction, penetrating keratoplasty, corneal refractive surgery, and glaucoma filtering surgery. Many microbial pathogens have been reported to cause infectious crystalline keratopathy (ICK), especially Gram-positive cocci, and streptococci in particular [4]. We present the first case of a patient with infectious crystalline keratopathy associated with Klebsiella oxytoca

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