Shewanella algae keratitis

Abstract

A 75-year-old male with a right eye history of chronic dry eye syndrome, glaucoma status post tube shunt, and Fuchs dystrophy status post Descemet stripping endothelial keratoplasty followed by penetrating keratoplasty (PKP) presented with a 2.7 × 4.2 mm corneal ulcer, culture positive for Shewanella algae and Klebsiella oxytoca. A topical antibiotic regimen of gentamicin 14 mg/mL and vancomycin 50 mg/mL was administered according to culture sensitivities. There was concurrent use of loteprednol 0.5% (Lotemax Gel, Bausch and Lomb, Rochester, NY, USA) and later addition of erythromycin 0.5% ointment. The corneal ulcer improved with antibiotic therapy but was complicated by poor patient follow-up. Descemetocele formation prompted PKP in the right eye. The graft was successful and visual acuity improved from a low of light perception to maximum of 20/200 Snellen.

Keywords: S. algae; keratitis; Shewanella; cornea ulcer.

Figure 1

(a) Day 1 – S. algae infected corneal ulcer measuring 2.7 × 4.2 mm (b) Day 1 – Corneal ulcer with fluorescein staining under cobalt blue light

Figure 2

(a) Day 22 – Resolving corneal ulcer with residual infiltrate and epithelial defect (b) Day 22 – Resolving corneal ulcer with fluorescein staining under cobalt blue light

Figure 3

Week 18 – Central descemetocele