FulminantSphingomonas paucimobiliskeratitis: case study and review of literature

Abstract

Sphingomonas paucimobilis is a low-virulence gram-negative bacillus known to cause various ocular infections such as endophthalmitis, panophthalmitis and keratitis that are usually associated with an underlying risk factor such as peri-partum or postpartum phase, cataract surgery, contact lens use, neurotrophic keratopathy or ocular trauma. We report a case of spontaneously occurring perforated corneal ulcer caused by the organism in a young man managed by penetrating keratoplasty. The course was followed by endophthalmitis with graft infection culminating in phthisis bulbi despite aggressive medical and surgical management. Along with reporting this case, we also present a review of literature on ocular infections caused by the same organism.

Multiple hepatosplenic abscesses in an immunocompetent host

“…3 Various case reports showing different infection sites of this organism are documented in literature like a splenic abscess, meningitis, osteomyelitis, secondary septic arthritis, bacteremia with septic pulmonary emboli, intra-abdominal abscess in a patient undergoing peritoneal dialysis, bacteremia outbreak in dialysis room among those using a common dialysis catheter, and paucimobilis fulminant keratitis. 2,[5][6][7][8][9][10] This case report is the second case of splenic abscess by S. paucimobilis documented in the literature, and probably the first case report of such an abscess in an immunocompetent host. The strain identified in the blood culture is susceptible to piperacillin/tazobactam, ceftriaxone, cefepime, imipenem, meropenem, amikacin, ciprofloxacin, and tigecycline.…”

Recurrent post-operative endophthalmitis caused by Sphingomonas paucimobilis despite vitrectomy – a case and review of the literature

“…First isolated from human specimens in 1977, Sphingomonas paucimobilis has traditionally been described in the literature as an opportunistic pathogen, typically associated with cases of meningitis, peritonitis, and septicaemia in the immunocompromised [ 6 , 7 ]. It’s involvement in ophthalmic disease has been limited further still, with only a few scattered case reports since 2006, describing a mix of endophthalmitis and infectious keratitis [ 4 ].…”

“…This low virulence is suspected to be the underlying mechanism by which patients develop an indolent endophthalmitis that often delays presentation, and how patients can have recurrence that occurs several months after treatment [ 9 ]. Somewhat paradoxically however, there are also cases reported of fulminant endophthalmitis occurring within days of surgery that are resistant to treatment and result in extremely poor visual outcomes [ 4 , 10 ].…”

“…One such gram-negative organism, Sphingomonas paucimobilis , has received relatively sparse coverage, with fewer than 10 total case reports in the last 15 years that implicate the organism in a postoperative endophthalmitis [ 4 ]. Known for its low virulence, the organism is more often seen in infections of the immunocompromised, although, cases have also been reported in healthy hosts.…”

“…Known for its low virulence, the organism is more often seen in infections of the immunocompromised, although, cases have also been reported in healthy hosts. While some authors report rapid resolution of symptoms and return to baseline visual acuity with appropriate treatment, the organism has also been characterised as a non-responder to aggressive surgical and medical management and thus warrants further research [ 4 ]. Here, we report a case of delayed acute onset of postoperative endophthalmitis involving S. paucimobilis that recurred despite aggressive treatment.…”