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2011 OMIG Abstract 26

Hyperacute infectious keratitis with Plesiomonas Shigelloides following
traumatic lamellar corneal laceration

M.H. Dastjerdi, F. Grigorian, E.D. Stahl, University of Kansas, Department of Ophthalmology, Kansas City, KS and Children's Mercy Hospitals and Clinics, Department of Ophthalmology, Kansas City, MO

Purpose: To describe the course and outcome of a case of bacterial keratitis with Plesiomonas Shigelloides after a traumatic lamellar corneal laceration.

Methods: A 13-year-old healthy female who sustained trauma to the right eye with a rock during a mud fight in a river.  She had immediate pain and decreased vision. The eye was rinsed with bottled water, and she continued worsening of lid swelling, along with pain and progressively decreased vision. Within less than 18 hours of incident, the patient was evaluated and taken to the operating room for exploration, which noted her to have a 5x4 mm non-penetrating lamellar corneal laceration, as well as a 1 mm layered hypopyon. The area around the corneal laceration was edematous and opaque with fluffy white infiltrate into the corneal stroma. Her laceration was not sutured. Corneal cultures were obtained and she was placed on hourly fortified tobramycin and moxifloxacin eye drops.

Results: Cultures from cornea grew Plesiomonas Shigelloides, a gram-negative bacillus found in freshwater, and typically associated with gastroenteritis due to contaminated food or water consumption.  Based on antimicrobial sensitivity tests, and considering the high virulence and infectivity of Plesiomonas Shigelloides, the keratitis was treated with intensive topical fortified amikacin 2% and levofloxacin 1.5% ophthalmic with minimal improvement in her clinical condition for several days.  She was taken to the operating room again for corneal ulcer debridement and re-cultures which were negative.  After two weeks of treatment, she developed a toxic reaction to topical medications.  Topical amikacin was stopped and levofloxacin 1.5% was switched to topical ciprofloxacin 0.3%, and patient was started on topical steroids.  The keratitis resolved very slowly over several days.

Conclusions:  Plesiomonas Shigelloides is a rare but high virulence cause of bacterial keratitis with hyperacute presentation.  

Disclosure Code: N

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