Iris root abscess and necrotizing sclerokeratitis caused by Mycobacterium abscessus and presenting as hemorrhagic anterior uveitis.
OBJECTIVE
To report a case of an iris abscess and necrotizing sclerokeratitis caused by Mycobacterium abscessus and presenting as hemorrhagic uveitis.


METHODS
An 86-year-old white woman was diagnosed with hemorrhagic anterior uveitis and treated with high-frequency topical steroids. The inflammation progressed to involve the cornea and the sclera, and the treatment was changed to intensive antibiotics. There was no improvement. Direct microscopy of a biopsy specimen of the lesion wrongly identified Nocardia as the cause, but antibiotic sensitivity suggested clarithromycin as a suitable therapeutic agent. Therapy was changed but there was continued deterioration. The eye could not be saved and the causative organism was subsequently discovered to be M. abscessus.


RESULTS
The eye was enucleated 6 months after initial presentation.


CONCLUSIONS
Ocular infection with M. abscessus is an extremely rare cause of necrotizing sclerokeratitis and may present as a hemorrhagic uveitis. There is a high risk of misdiagnosis and late detection, which may have severe consequences.
Clare
Gerry
G
Western Eye Hospital, London, UK.
Mitchell
Suzanne
S
D000038:Abscess / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000382:microbiology*; D000369:Aged, 80 and over; D000890:Anti-Infective Agents / Q000627:therapeutic use; D003320:Corneal Ulcer / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000382:microbiology*; D015353:Eye Enucleation; D015818:Eye Infections, Bacterial / Q000382:microbiology; D005260:Female; D006801:Humans; D006988:Hyphema / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D007499:Iris Diseases / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000382:microbiology*; D009165:Mycobacterium Infections, Nontuberculous / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000382:microbiology*; D009170:Nontuberculous Mycobacteria / Q000302:isolation & purification*; D015423:Scleritis / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000382:microbiology*; D014463:Ultrasonography; D014606:Uveitis, Anterior / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*
D000890:Anti-Infective Agents