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Infectious Crystalline Keratopathy Caused by Klebsiella Oxytoca

Infectious Crystalline Keratopathy Caused by Klebsiella Oxytoca. Rohit Adyanthaya, MD, Timothy Chou, MD, Lorena LoVerde, BS. SUNY Eye Institute, Stony Brook University, NY The authors have no financial interests to disclose. Purpose.

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Infectious Crystalline Keratopathy Caused by Klebsiella Oxytoca

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  1. Infectious Crystalline Keratopathy Caused by Klebsiella Oxytoca Rohit Adyanthaya, MD, Timothy Chou, MD, Lorena LoVerde, BS. SUNY Eye Institute, Stony Brook University, NY The authors have no financial interests to disclose.

  2. Purpose To report a novel case of a Klebsiella oxytoca infectious crystalline keratopathy

  3. Background • Infectious crystalline keratopathy (ICK) is a slowly progressing corneal infection characterized by branching, grayish-white, needle-like opacities within the corneal stroma, with a paucity of corneal and anterior segment inflammation. • Risk factors for infectious crystalline keratopathy include previous corneal surgery, long-term topical corticosteroid use, and prior corneal disease.

  4. Background • Many organisms have been identified as causative agents in ICK. Gram positive alpha hemolytic streptococci, typically of the Viridans group, are the most common pathogens encountered. • Gram negative organisms have also been implicated in ICK, on occasion, such as Pseudomonas and Serratia marcescens.

  5. Methods Retrospective case report. Medical records were reviewed for past ocular and medical history.

  6. Findings CASE REPORT: An 80-year-old woman presented with complaint of a white spot in the left eye for the past two to three days. The patient noticed mild soreness and discharge. She had a complicated past ocular history including a failed penetrating keratoplasty. At the time of presentation she was being maintained on prednisolone acetate 1%, twice per day.

  7. Findings • CASE REPORT (continued): There was an extensive stromal ulcer and infiltrate in the transplant involving much of its inferior and central aspects, bordered by the graft edge. Extending upward from the infiltrate into the superonasal graft were branching, needle-like deep stromal opacities (see figure in next slide).

  8. Slit lamp photograph of infectious keratitis in the graft. Arrow points to branching needle-like pattern of infiltrate.

  9. Results • Corneal scrapings demonstrated Gram-negative bacilli. The organism was identified as Klebsiella oxytoca on culture. • The patient was placed on double antibiotic therapy with hourly moxifloxacin* 0.3% and fortified tobramycin 15 mg/ml. After 2 months of treatment, there was gradual resolution of the infection, with healing of the ulcer and scarring of the infiltrate. *Moxifloxacin eyedrops for keratitis is an off-label use of the drug

  10. Conclusions • This is the first reported case of Klebsiella oxytoca as a cause of infectious crystalline keratopathy. • Eradication of the infection required prolonged treatment with double topical antibiotic therapy. • More study may be required to determine if this approach results in faster resolution than monotherapy, or reduces the need for surgical intervention.

  11. References • Gorovoy MS, Stern GA, Hood CI, et al. Intrastromal noninflammatory bacterial colonization of a corneal graft. Arch Ophthalmology. 1983;101:1749–1752. • Sharma N, Vajpayee RB, Pushker N et al. Infectious Crystalline Keratopathy. CLAO J. 2000 Jan;26(1):40-3. • Dietrich T, Walter G, Schlotzer-Schrehardt U et al. Borrelia- associated Crystalline Keratopathy With Intrastromal Detection of Borrelia garinii by Electron Microscopy and Polymerase Chain Reaction. Cornea 2008;27:498-500 • Umapathy T, Singh R, Dua SH et al. Non-tuberculous mycobacteria related infectious crystalline keratopathy. Br J Ophthalmol 2005 Oct; 89(10):1374-5 • Tu EY, Joslin CE, Nijm LM et al. Polymicrobial keratitis: Acanthoamoeba and infectious crystalline keratopathy. American Journal of Ophthalmology. 2009 July; 148(1):13-9.e2. • Verma K, Vajpayee RB, Titiyal JS et al. Post-LASIK infectious crystalline keratopathy caused by Alternaria. Cornea. 2005 Nov;24(8):1018-20. • Chen CL, Tai MC, Chen JT et al. Infectious crystalline keratopathy caused by Serratia marcescens. Cornea. 2007 Sep;26(8):1011-3 • Hogenauer C, Langner C, Beubler E et al. Klebsiella oxytoca as a Causative Organism of Antibiotic-Associated Hemorrhagic Colitis. N Engl J Med 355;23:2418-2426. • Tang LM, Chen ST: Klebsiella oxytoca meningitis: frequent association with neurosurgical procedures. Infection 1995, 23(3):163-167. • Hori K, Yasoshima H, Yamada A et al: Adrenal hemorrhage associated with Klebsiella oxytoca bacteremia. Intern Med 1998, 37(11):990-994. • Haddad J, Marcato N, Cassan P: Septic shock caused by Klebsiella oxytoca after colonoscopy. Gastroenterol ClinBiol 1994, 18(2):181-182. • Butler T, Dua H, Edwards R et al. In Vitro Model of Infectious Crystalline Keratopathy: Tissue Architecture Determines Pattern of Microbial Spread.Investigative Ophthalmology & Visual Science, May 2001, Vol. 42, No. 6: 1243-1246. • Masselos K, Tsang HH, Ooi JL et al. Laser corneal biofilm disruption for infectious crystalline keratopathy. Clin Experiment Ophthalmol. 2009 Mar;37(2):177-80. Epub 2008 Dec 29.

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