Acute exacerbation of staphylococcal catarrhal infiltration associated with treatment for Pseudomonas aeruginosa keratitis: A case report

摘要

Rationale: Simultaneous presentation of peripheral infiltrates, which can be easily misidentified as satellite lesions, is rarely observed in patients with acute infectious keratitis . Patient concerns: A 70-year-old woman was referred to our clinic due to acute mucopurulent keratitis following application of a therapeutic soft contact lens for the treatment of epithelial defects caused by entrance of soil foreign bodies into the eye. The patient was diagnosed with Pseudomonas keratitis , following which she was treated with alternating administration of fourth-generation fluoroquinolone (Vigamox) and 5% fortified ceftazidime eyedrops every 2 hours. Although infectious keratitis rapidly improved, discrete catarrhal infiltrates at the corneolimbal junction (10- to 2-o’clock and 7- to 8-o’clock positions) were rapidly aggravated, forming bead-like stromal pustules inversely proportional to the extent of Pseudomonas keratitis . Diagnosis: Acute exacerbation of staphylococcal catarrhal infiltration associated with treatment for Pseudomonas aeruginosa keratitis . Interventions: Addition of 1% prednisone acetate eyedrops (Pred Forte) four times per day. Outcomes: Dramatic improvement was observed at the sites of catarrhal infiltration without recurrence of infectious keratitis . Lessons: Clinicians should thus remain aware of the risk for co-occurring non-infectious, immune-related keratitis , as treatment for infectious keratitis may induce significant aggravation of non-infectious keratitis .