Photo Quiz (For answer and discussion, see page 2843 in this issue [doi:10.1128/JCM.00543-12])
A 69-Year-Old Male with Chronic Keratitis
FIG 1 (A) Hematoxylin and eosin stain of the corneal biopsy specimen. Magnification, ⫻100. (B) Hematoxylin and eosin stain of the corneal biopsy specimen. Magnification, ⫻1,000. (C) Corneal biopsy culture. Magnification, ⫻400.
A
69-year-old male developed painful chronic keratitis, scleritis, and a corneal ulcer. He had no history of contact use and recalled no trauma to the eye; however, the eye had a mature cataract. The patient was initially treated for viral keratitis with topical vidarabine and oral acyclovir, based on the physical appearance of the lesion as well as negative bacterial and fungal cultures and lack of response to ophthalmic antibacterial drops. The patient’s condition continued to decline over an 8-month period, during which the eye developed a persistent epithelial defect. He was subsequently referred to an ophthalmologist for assessment. The ophthalmologist discussed the risks of surgery, including bleeding, progressive infection, loss of vision, increased pain, and need for additional surgery. The patient underwent an amniotic membrane placement to close the persistent epithelial defect in the cornea. At the time of surgery, a 3-mm biopsy punch was used to make a partial-thickness corneal incision. A crescent blade was used to excise the specimens, which were sent to the surgical pathology and microbiology departments. Sections of amniotic membrane were used to fit the areas of epitheliallossonthecornealandscleralsurfaces.Afterthesurgery,asubconjunctival injection of cefazolin was administered and bacitracin
August 2012 Volume 50 Number 8
polymyxin ointment and moxifloxacin were placed in the conjunctival fornix. The causative agent was detected by light microscopy with hematoxylin-and-eosin-stained sections of the corneal biopsy specimen (Fig. 1A and B) and by corneal biopsy culture (Fig. 1C). Steven D. Dallas UTHSC San Antonio Department of Pathology San Antonio, Texas, USA
Sarah K. Hartman Transfusion Medicine Fellow Department of Pathology Baylor College of Medicine at Texas Children’s Hospital Houston, Texas, USA
Address correspondence to Steven D. Dallas,
[email protected]. Copyright © 2012, American Society for Microbiology. All Rights Reserved. doi:10.1128/JCM.00542-12
Journal of Clinical Microbiology
p. 2545
jcm.asm.org
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