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Infectious Crystalline
Keratopathy Caused by Klebsiella
Oxytoca
Rohit Adyanthaya, MD,
Timothy Chou, MD,
Lorena LoVerde, BS.
SUNY Eye Institute, Stony Brook University, NY
The authors have no financial interests to disclose.
Purpose
To report a novel case of a Klebsiella
oxytoca infectious crystalline keratopathy
Background
• Infectious crystalline keratopathy (ICK) is a
slowly progressing corneal infection
characterized by branching, grayish-white,
needle-like opacities within the corneal
stroma, with a paucity of corneal and anterior
segment inflammation.
• Risk factors for infectious crystalline
keratopathy include previous corneal surgery,
long-term topical corticosteroid use, and prior
corneal disease.
Background
• Many organisms have been identified as
causative agents in ICK. Gram positive alpha
hemolytic streptococci, typically of the
Viridans group, are the most common
pathogens encountered.
• Gram negative organisms have also been
implicated in ICK, on occasion, such as
Pseudomonas and Serratia marcescens.
Methods
Retrospective case report. Medical
records were reviewed for past ocular
and medical history.
Findings
CASE REPORT: An 80-year-old woman
presented with complaint of a white spot in
the left eye for the past two to three days. The
patient noticed mild soreness and discharge.
She had a complicated past ocular history
including a failed penetrating keratoplasty. At
the time of presentation she was being
maintained on prednisolone acetate 1%, twice
per day.
Findings
• CASE REPORT (continued):
There was an extensive stromal ulcer and
infiltrate in the transplant involving much of
its inferior and central aspects, bordered by
the graft edge. Extending upward from the
infiltrate into the superonasal graft were
branching, needle-like deep stromal opacities
(see figure in next slide).
Slit lamp photograph of infectious keratitis in the graft. Arrow
points to branching needle-like pattern of infiltrate.
Results
• Corneal scrapings demonstrated Gramnegative bacilli. The organism was identified
as Klebsiella oxytoca on culture.
• The patient was placed on double antibiotic
therapy with hourly moxifloxacin* 0.3% and
fortified tobramycin 15 mg/ml. After 2 months
of treatment, there was gradual resolution of
the infection, with healing of the ulcer and
scarring of the infiltrate.
*Moxifloxacin eyedrops for keratitis is an off-label use of the drug
Conclusions
• This is the first reported case of Klebsiella
oxytoca as a cause of infectious crystalline
keratopathy.
• Eradication of the infection required
prolonged treatment with double topical
antibiotic therapy.
• More study may be required to determine if
this approach results in faster resolution than
monotherapy, or reduces the need for surgical
intervention.
References
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Gorovoy MS, Stern GA, Hood CI, et al. Intrastromal noninflammatory bacterial colonization of a corneal graft. Arch
Ophthalmology. 1983;101:1749–1752.
Sharma N, Vajpayee RB, Pushker N et al. Infectious Crystalline Keratopathy. CLAO J. 2000 Jan;26(1):40-3.
Dietrich T, Walter G, Schlotzer-Schrehardt U et al. Borrelia- associated Crystalline Keratopathy With Intrastromal Detection of
Borrelia garinii by Electron Microscopy and Polymerase Chain Reaction. Cornea 2008;27:498-500
Umapathy T, Singh R, Dua SH et al. Non-tuberculous mycobacteria related infectious crystalline keratopathy. Br J Ophthalmol
2005 Oct; 89(10):1374-5
Tu EY, Joslin CE, Nijm LM et al. Polymicrobial keratitis: Acanthoamoeba and infectious crystalline keratopathy. American
Journal of Ophthalmology. 2009 July; 148(1):13-9.e2.
Verma K, Vajpayee RB, Titiyal JS et al. Post-LASIK infectious crystalline keratopathy caused by Alternaria. Cornea. 2005
Nov;24(8):1018-20.
Chen CL, Tai MC, Chen JT et al. Infectious crystalline keratopathy caused by Serratia marcescens. Cornea. 2007
Sep;26(8):1011-3
Hogenauer C, Langner C, Beubler E et al. Klebsiella oxytoca as a Causative Organism of Antibiotic-Associated Hemorrhagic
Colitis. N Engl J Med 355;23:2418-2426.
Tang LM, Chen ST: Klebsiella oxytoca meningitis: frequent association with neurosurgical procedures. Infection 1995,
23(3):163-167.
Hori K, Yasoshima H, Yamada A et al: Adrenal hemorrhage associated with Klebsiella oxytoca bacteremia. Intern Med 1998,
37(11):990-994.
Haddad J, Marcato N, Cassan P: Septic shock caused by Klebsiella oxytoca after colonoscopy. Gastroenterol Clin Biol 1994,
18(2):181-182.
Butler T, Dua H, Edwards R et al. In Vitro Model of Infectious Crystalline Keratopathy: Tissue Architecture Determines Pattern
of Microbial Spread. Investigative Ophthalmology & Visual Science, May 2001, Vol. 42, No. 6: 1243-1246.
Masselos K, Tsang HH, Ooi JL et al. Laser corneal biofilm disruption for infectious crystalline keratopathy. Clin Experiment
Ophthalmol. 2009 Mar;37(2):177-80. Epub 2008 Dec 29.