An unusual case of corneal perforation secondary to Pseudomonas keratitis complicating a patient's surgical/trauma intensive care unit stay.
We report a case of corneal perforation secondary to bacterial keratitis caused by Pseudomonas aeruginosa in a trauma patient in our intensive care unit. A 43-year-old man was involved in a motorcycle crash and suffered multiple injuries necessitating a prolonged intensive care unit (ICU) stay. Subsequently P. aeruginosa was cultured from his sputum, blood, and open abdomen. He developed a bacterial keratitis in his right eye, which also grew P. aeruginosa. This infection rapidly progressed to corneal perforation requiring a Gunderson conjunctival flap and lateral tarsorrhaphy in addition to aggressive antibiotic treatment. At the time of discharge from the hospital the patient had the return of vision to light only in his right eye. Corneal perforation is an unusual event in the ICU. Prevention or early detection of bacterial keratitis with aggressive antibiotic treatment is needed to prevent such complications. Pseudomonas is one of the more virulent organisms that can infect the cornea and early identification is paramount for a good outcome. Management of this complicated case is discussed and the limited amount of literature on nosocomial bacterial keratitis in the ICU is reviewed.
Department of Surgical Education, Orlando Regional Medical Center, Florida, USA.
J L
JL
Johnson
S G
SG
Sagraves
C J
CJ
Feild
E F
EF
Block
M L
ML
Cheatham
D000328:Adult; D003228:Conjunctiva / Q000637:transplantation; D003320:Corneal Ulcer / Q000175:diagnosis* / Q000601:surgery; D003428:Cross Infection / Q000175:diagnosis* / Q000601:surgery; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D009104:Multiple Trauma / Q000601:surgery*; D011183:Postoperative Complications / Q000175:diagnosis / Q000601:surgery*; D011552:Pseudomonas Infections / Q000175:diagnosis* / Q000601:surgery; D012086:Reoperation; D018805:Sepsis / Q000175:diagnosis / Q000601:surgery; D013156:Splenectomy; D013524:Surgical Flaps; D014792:Visual Acuity