Self-inflicted Chronic Bacterial Keratoconjunctivitis Using Self Semen
A 20-year-old male soldier was referred to our clinic for the evaluation of refractory chronic bacterial conjunctivitis. Over the previous 4 months, he had been treated for copious mucous discharge, conjunctival injection, and superficial punctate keratitis on both eyes at an army hospital and a local eye clinic. The transfer note stated that Citrobacter koseri was cultured from a conjunctival swab, but targeted topical and systemic antibiotic treatment based on antimicrobial susceptibility testing had not been effective.\nIn our clinic, he also complained of ocular redness, pain, and severe discharge in both eyes. Best-corrected visual acuity was 20 / 20 in both eyes. Slit lamp examination showed multiple punctate erosions on the inferior cornea and severe conjunctival injection on both bulbar and palpebral conjunctiva (). Mucous discharge was observed in both eyes (). Other ophthalmic examinations were within normal limits.\nPrior to topical antibiotic treatment, conjunctival swabs were collected for smear and culture. Moxifloxacin 0.5% ophthalmic solution (Vigamox; Alcon Laboratories, Fort Worth, TX, USA) was prescribed for use every 2 hours. The conjunctival swabs revealed a mixed infection of Acinetobacter baumannii and Staphylococcus xylosus. As S. xylosus was reported to be resistant to moxifloxacin, topical vancomycin eye drops were added; however, despite 4 weeks of topical antibiotic treatment, the patient showed no improvement. On the repeated conjunctival swabs, microorganisms continued to be cultured, but different bacterial strains were observed, including A. baumannii and Chryseobacterium indologenes. The patient's complete blood count was normal, and serologic tests such as human immundeficiency virus antibody were negative.\nDuring the repeated smear and culture of conjunctival swabs, surprisingly, a few sperm were detected on Gram staining (), revealing that the condition was a self-inflicted bacterial keratoconjunctivitis involving the patient's own semen. We informed the patient and his father of the smear results and recommended a psychiatric consultation.