title: Atopic keratoconjunctivitis complicated byKocuria koreensiskeratitis: the first case.
abstract: BACKGROUND
  Patients with atopic dermatitis have a predisposition toStaphylococcus aureusand aHerpes simplexvirus infection. The treatment of atopic diseases with steroid and immunosuppressive agents induces opportunistic infection. However, there is a concern regarding visual prognosis in patients with atopic keratoconjunctivitis (AKC) complicated with infectious keratitis. We report an unusual case of an atopic shield ulcer withKocuriakeratitis.
  
  
  METHODS
  A 51-year-old Japanese man presented with a 14-day history of eye pain and visual loss in his left eye. At the initial examination, a shield ulcer was observed in the upper-central cornea of the left eye, and the conjunctiva in both eyes had a velvety appearance due to papillary formation, as well as hyperemia and swelling in the palpebral area. The shield ulcer showed white stromal opacification in the marginal zone with a coral-like appearance. Samples were obtained by corneal scraping, andKocuriasp. was identified by microbiological examination including culture and matrix-assisted laser desorption/ionization time-of-flight mass spectrometry. The 16S rRNA gene sequence analysis was performed using isolated Kocuria strain from the patient. The obtained DNA sequence showed 99% homology withKocuria koreensis.The combination of corneal scraping and instillation of cefmenoxime antibiotic ophthalmic solution was considered useful for the treatment ofKocuriakeratitis.
  
  
  CONCLUSIONS
  Clinicians should be aware ofKocuriakeratitis as a corneal complication of AKC, and that rapid diagnosis ofKocuriakeratitis may improve visual prognosis.
authors.affiliation: Department of Visual Sciences, Division of Ophthalmology, School of Medicine, Nihon University, 30-1, Oyaguchi-Kamicho, Itabashi-ku, Tokyo 173-8610 Japan.
authors.forename: Noriko
authors.initials: N
authors.lastname: Inada
authors.affiliation: Department of Visual Sciences, Division of Ophthalmology, School of Medicine, Nihon University, 30-1, Oyaguchi-Kamicho, Itabashi-ku, Tokyo 173-8610 Japan.
authors.forename: Jun
authors.initials: J
authors.lastname: Shoji
authors.affiliation: Department of Visual Sciences, Division of Ophthalmology, School of Medicine, Nihon University, 30-1, Oyaguchi-Kamicho, Itabashi-ku, Tokyo 173-8610 Japan.
authors.forename: Satoru
authors.initials: S
authors.lastname: Yamagami
keywords: Atopic dermatitis; Atopic keratoconjunctivitis; Kocuria keratitis; Shield ulcer