Streptococcus mitis/oralis Corneal Ulcer in a Patient with Severe Rheumatoid Arthritis: An Unusual Route

Abstract

Purpose. To report a case of Streptococcus mitis oralis (S. mitis/oralis) corneal ulcer in a patient with a possible preventable cause. Methods. Cultures were obtained from a 64-year-old woman with a 3.5 mm × 5 mm corneal ulcer with hypopyon in the left eye. Results. Culture reports demonstrated the growth of S. mitis/oralis, a commensal organism of the oral flora. Fortified vancomycin 5% eye drops were started, and the patient was counseled on the rarity of the bacteria as an etiology of corneal ulcers. On the return visit, the patient, who works in a doctor’s office, volunteered information that the preservative free artificial tear vials that she used were difficult to open because of her hand deformity due to rheumatoid arthritis; thus, she had to bite the vials open. Conclusions. S. mitis/oralis is an organism commonly found in the mouth but is rarely found in the eye. We report a unique case of an immunocompromised patient with rheumatoid arthritis, severe dry eye, and a history of multiple episodes of keratolysis, who developed a corneal ulcer from a rare pathogen, with a plausible and preventable route of infection.

Multidrug-Resistant Pseudomonas aeruginosa Keratitis Associated With Artificial Tear Use

“…Artificial tears are used to relieve dry eye symptoms and improve corneal epithelial healing. It is rare for keratitis to be specifically associated with contaminated artificial tears, although 1 case of Streptococcus mitis keratitis was attributed to a patient with rheumatoid arthritis biting the tops of her artificial tears bottles . The CDC recently reported that 55 patients in 12 states developed MDR P aeruginosa keratitis potentially associated with EzriCare artificial tear use with outcomes including permanent blindness, hospitalization, and death due to systemic infection .…”