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Year : 2021  |  Volume : 1  |  Issue : 2  |  Page : 244-245

A rare case of infectious crystalline keratopathy caused by Burkholderia cepacia

1 Aravind Eye Hospital, Cornea Department, Pondicherry, India
2 Aravind Eye Hospital, Retina Department, Pondicherry, India
3 Wilmer Eye Institute, John Hopkins University, USA

Correspondence Address:
Dr. Vaibhav Khanna
Aravind Eye Hospital, Main Cuddalore Road, Thavalakuppam, Pondicherry . 605 007
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijo.IJO_1402_20

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We report a unique case of infectious crystalline keratopathy (ICK) caused by Burkholderia cepacia in a 47-year-old patient with history of multiple penetrating keratoplasties (PKPs). Slit-lamp examination revealed a white nonsuppurative needle-like branching anterior stromal infiltrate. Microscopic examination of the Gram-stained smear showed gram-negative bacilli. Cultures revealed Burkholderia cepacia, which was multidrug resistant and sensitive to piperacillin/tazobactam. Based on antibiotic sensitivity report, patient was started fortified piperacillin-tazobactam (0.32%) eye drop on an hourly basis. After 8 weeks of aggressive therapy, the infiltrate resolved with subsequent corneal scarring and vascularization. To our knowledge, this is the first reported case of Burkholderia-related ICK. ICK, first described by Gorovoy et al.[1] in 1983, is an indolent keratitis with characteristic needle-like branching opacities in the absence of corneal or anterior segment inflammation.[2] The presence of an immunocompromised corneal state, such as chronic topical steroid use post PKP, is a known risk factor for the development of ICK. Other risk factors include surgical procedures such as lamellar keratoplasty, corneal cross-linking, laser-assisted in situ keratomileusis, pterygium excision, and trabeculectomy with 5- FU. Topical anaesthetic abuse as a risk factor has also been described.[3] Burkholderia is a group of Gram-negative bacteria, composed of at least 20 different species. We describe a case of Burkholderia keratitis presenting as ICK in a patient who underwent multiple PKPs and a history of long-term topical steroid therapy.

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