Posttraumatic Stenotrophomonas maltophilia infectious scleritis.
OBJECTIVE
To describe the history, clinical presentation, and successful surgical and antibiotic management of a case of posttraumatic infectious scleritis secondary to Stenotrophomonas maltophilia.


METHODS
A 51-year-old white man presented with worsening light sensitivity, localized conjunctival hyperemia, and a painful scleral nodule in his right eye that developed over a period of 1 month after minor ocular trauma. The patient was treated by his referring ophthalmologist for "episcleritis" with fluorometholone 0.1%, 1 drop 4 times a day, since injury onset without clinical improvement. Evaluation consisted of slit-lamp examination, ultrasound biomicroscopy, and surgical exploration with tissue cultures and histology.


RESULTS
Ultrasound biomicroscopy of the right eye revealed the presence of a dome-shaped mass overlying an area of partial-thickness scleral laceration in the inferotemporal quadrant. The scleral nodule was surgically excised, and the scleral laceration was repaired with one 8-0 nylon suture. Culture results revealed infection by S. maltophilia, which was resistant to gentamicin, tobramycin, and trimethoprim-sulfamethoxazole. The patient experienced immediate pain relief after surgery, and treatment was continued with both topical ciprofloxacin 0.3% and prednisolone acetate 1% for 1 month with full recovery.


CONCLUSIONS
S. maltophilia should be considered in the differential diagnosis of posttraumatic infectious scleritis. Submission of appropriate surgical specimens for microbiologic analysis and adequate antibiotic therapy may prevent the development of endophthalmitis in cases of suspected posttraumatic infectious scleritis.
Ramos-Esteban
Jerome C
JC
Cole Eye Institute, Cleveland Clinic, Cleveland, OH 44195, USA.
Jeng
Bennie H
BH
D002939:Ciprofloxacin / Q000627:therapeutic use; D003131:Combined Modality Therapy; D003228:Conjunctiva / Q000293:injuries*; D004359:Drug Therapy, Combination; D005129:Eye Foreign Bodies / Q000382:microbiology*; D015818:Eye Infections, Bacterial / Q000000981:diagnostic imaging / Q000382:microbiology* / Q000628:therapy; D016905:Gram-Negative Bacterial Infections / Q000000981:diagnostic imaging / Q000382:microbiology* / Q000628:therapy; D006801:Humans; D008297:Male; D033401:Microscopy, Acoustic; D008875:Middle Aged; D013508:Ophthalmologic Surgical Procedures; D011239:Prednisolone / Q000031:analogs & derivatives / Q000627:therapeutic use; D015423:Scleritis / Q000000981:diagnostic imaging / Q000382:microbiology* / Q000628:therapy; D020615:Stenotrophomonas maltophilia / Q000302:isolation & purification*
D002939:Ciprofloxacin; C009935:prednisolone acetate; D011239:Prednisolone