Deep stromal mycobacterial keratitis: viable bacteria after six months of treatment: case report and literature review

Arquivos Brasileiros de Oftalmologia

Filipe Accioly De Gusmão²  Lênio Alvarenga¹  Luciene Barbosa¹  Jorge Sampaio¹  Sylvia Cardoso Leão¹  Ana Luisa Hofling-lima¹  Denise De Freitas¹ 

[1] ,Universidade Federal de São PauloSão Paulo SP

关键词: Eye foreign bodies;    Keratitis;    Cornea;    Eye infections;    bacterial;    Mycobacteria;    atypical;    Mycobacterium fortuitum;    Mycobacterium chelonae;    Case report;    Corpos estranhos no olho;    Ceratite;    Córnea;    Infecções oculares bacterianas;    Micobactérias atípicas;    Mycobacterium fortuitum;    Mycobacterium chelonae;    Relato de caso;   

DOI  :  10.1590/S0004-27492005000400024

来源: SciELO

【 摘 要 】

To report the presence of viable mycobacteria in a patient with keratitis treated for 6 months. Species identification was performed using the PRA method (polymerase chain reaction followed by restriction endonuclease analysis). Clonality was evaluated with RAPD (randomly amplified polymorphic DNA) and ERIC-PCR (enterobacterial repetitive intergenic consensus - polymerase chain reaction) methods. The patient reported trauma due to a metallic foreign body 3 weeks prior to presentation. Initial corneal scraping cultures revealed Mycobacterium abscessus. After 6 months of topical and systemic treatment the patient presented with no active inflammation and was considered clinically cured. An optic penetrating keratoplasty was performed. Culture of the excised cornea revealed Mycobacterium abscessus. Both isolates had the same clonal origin. The most interesting finding of this case report was the positive culture of the excised cornea after 6 months of intensive specific topical therapy. To our knowledge, this is the first report in the literature showing this possibility in the treatment of Mycobacterial keratitis. Thus, Mycobacterium abscessus may present viable bacteria after long-term treatment and should be followed carefully for a long period of time after tapering the medication.

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