title: Severe Staphylococcus lugdunensis keratitis.
abstract: We report a severe case of Staphylococcus lugdunensis (S. lugdunensis) keratitis presenting as suppurative keratitis in a 77-year-old woman. The patient's chief complaint was eye pain and decreased visual acuity in her right eye. Suppurative keratitis with a severe corneal abscess was diagnosed by a slit-lamp ophthalmic examination. The causative organism was identified as S. lugdunensis by bacterial culture, using a corneal abrasion specimen. She was treated with an intravenous drip infusion of ceftazidime and instillation of gentamicin sulfate ophthalmic solution (six times daily) and ofloxacin ophthalmic ointment (once daily before bedtime) as empiric therapy. Her hospital course was complicated by a corneal perforation of her right eye. The antibiotic susceptibility for S. lugdunensis was sensitive, but with a slightly high MIC for antibiotics used in empiric therapy. The therapeutic drug was changed to levofloxacin ophthalmic solution. The corneal abscess left a scar after healing. Representative causative organisms of suppurative keratitis include Pseudomonas aeruginosa and Streptococcus pneumoniae, but care must be taken in cases involving rare causative organisms. Empiric therapy is necessary for rapidly progressing suppurative keratitis, but a detailed examination of the causative organism is important for therapeutic planning before empiric therapy.
authors.affiliation: Division of Ophthalmology, Department of Visual Sciences, Nihon University School of Medicine, 30-1 Oyaguchi-Kamichou, Itabashi-ku, Tokyo, 173-8610, Japan, inada.noriko@nihon-u.ac.jp.
authors.forename: N
authors.initials: N
authors.lastname: Inada
authors.forename: N
authors.initials: N
authors.lastname: Harada
authors.forename: M
authors.initials: M
authors.lastname: Nakashima
authors.forename: J
authors.initials: J
authors.lastname: Shoji
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use; D005123:Eye / Q000382:microbiology / Q000473:pathology; D015818:Eye Infections, Bacterial; D005260:Female; D006801:Humans; D007634:Keratitis; D008826:Microbial Sensitivity Tests; D013203:Staphylococcal Infections; D057787:Staphylococcus lugdunensis / Q000187:drug effects / Q000302:isolation & purification
chemical_list: D000900:Anti-Bacterial Agents
references.citation: Infection. 2013 Apr;41(2):525-8
references.pmid: 23242962
references.citation: Br J Ophthalmol. 1999 Jul;83(7):771-3
references.pmid: 10381660
references.citation: Invest Ophthalmol Vis Sci. 2010 May;51(5):2519-24
references.pmid: 20019362
references.citation: Clin Exp Ophthalmol. 2011 Jul;39(5):393-7
references.pmid: 21176039
references.citation: J Clin Microbiol. 2005 Nov;43(11):5808-10
references.pmid: 16272527
references.citation: J Microbiol Immunol Infect. 2015 Aug;48(4):406-12
references.pmid: 24529852
references.citation: J Clin Microbiol. 2005 Mar;43(3):1149-57
references.pmid: 15750076