Keratitis with Elizabethkingia meningoseptica Occurring after Contact Lens Wear: A Case Report
A 24-year-old male patient visited our hospital due to right ocular pain. He had been wearing soft contact lenses for six months, for approximately 10 hours per day. He had no medical history of ocular injury, surgery, or treatment with either ophthalmic or systemic medications. No abnormality was found in the blood test. On our initial examination, visual acuity was 20 / 25 in the right eye and 20 / 20 in the left eye. Slit lamp examination revealed hyperemia of the right bulbar conjunctiva near the lesion and a corneal epithelial defect sized 0.5 mm × 0.5 mm accompanied by intra-stromal infiltration and peripheral neovascularization toward the 7 o'clock direction of the limbus (). The lens, vitreous body, and retina were all normal. Corneal scraping was performed for microbiologic investigation. A bacteriological test was conducted on the corneal scrapings, contact lens, lens case and lens washing agent. The patient was treated as follows: 3% gatifloxacin (Gatiflo; Handok, Seoul, Korea) with an initial one-hour interval and a later reduced frequency; 2% homatropine (Ocuhomapine Eye; Samil, Seoul, Korea), three times a day; and 0.3% unpreserved hyaluronic acid (Hyalein mini; Santen, Osaka, Japan), four times a day. Three days later, when the patient revisited the hospital, the symptoms had improved. The corneal epithelial defect was nearly healed, and the corneal intra-stromal infiltration was also decreased. After the initial bacterial culture, bacteria were inoculated and cultured in blood agar at an intermediate level, in all the prelevated specimens (). Elizabethkingia meningoseptica was identified using the Vitek 2 GN colorimetric identification card (Biomerieux Vitek, Hazelwood, MO, USA). Elizabethkingia meningoseptica were sensitive to ciprofloxacin, trimethoprim/sulfamethoxazole, levofloxacin, gentamycin, piperacillin/tazobactam and amikacin. The patient was continued on 3% gatifloxacin (Gatiflo) and 0.3% unpreserved hyaluronic acid (Hyalein mini), four times a day. However, 2% homatropine (Ocuhomapine Eye) was discontinued. Complete re-epithelialization of the lesion was observed within the sub-epithelial corneal opacity on the seventh day after treatment (). After two weeks, the patient was being treated only with 0.3% unpreserved hyaluronic acid (Hyalein mini), four times a day. His final corrected visual acuity in the right eye was 20 / 20.