Challenges in the Management of Ocular Nontuberculous Mycobacterial Infection: Two Cases
Purpose
To describe two ocular cases of nontuberculous mycobacterial (NTM) infection.
Methods
Retrospective chart review.
Results
57 year-old man with bilateral retinal detachment, post scleral buckle presented with inflammation, burning and pain OD after a trip to Aruba. Patient diagnosed with scleritis and keratitis with corneal abscess. Mycobacterium abscessus identified after two scleral biopsies and corneal biopsy. Initial therapy was IV vancomycin and ceftazidime, topical azithromycin, amikacin, voriconazole, and oral voriconazole. 2 years later, he is on topical azithromycin, amikacin, prednisolone, oral azithromycin, omadacycline, and intravitreal amikacin. His infection is controlled but unresolved.
62 year-old woman with rheumatoid arthritis on abatacept and leflunomide and Sjögren’s syndrome presented with keratitis and perforated corneal ulcer. The perforation was sealed with glue; the keratitis waxed and waned for 4 months, partly responsive to systemic steroids. Cultures were negative initially, but later AFB stain and culture showed Mycobacterium chelonae. Topical amikacin, moxifloxacin, and oral azithromycin started with good clinical response.
Conclusion
NTM infections are usually associated with trauma or corneal refractive surgery. In cases of infectious keratitis and scleritis with unusual presentation and response to treatment, suspect NTM infections. Patients with atypical environmental exposures or immunosuppression are at risk for NTM infection. NTM keratitis and scleritis can be difficult to treat and require chronic multimodal antibiotic therapies.
Conflict of interest
No
Authors 1
Last name
KIM
Initials of first name(s)
E
Department
Icahn School of Medicine at Mount Sinai
City
New York
Country
United States
Authors 2
Last name
Chu
Initials of first name(s)
KH
Department
MERSI
City
Palisades Park
Country
United States
Authors 3
Last name
Chu
Initials of first name(s)
DS
Department
MERSI
City
Palisades Park
Country
United States
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