Ochrobactrum anthropi Keratitis with Focal Descemet’s Membrane Detachment and Intracorneal Hypopyon

Figure 1

(a) External slit-lamp photograph of patient’s left eye on initial referral. Exam is notable for 1+ conjunctival hyperemia, edema, thinning, and neovascularization of the cornea. A central ulcer with surrounding opacities is also present along with a focally detached Descemet’s membrane and an intracorneal hypopyon (blue arrow). Multiple keratitic precipitates (with overlying edema) are noted inferotemporally and appear disciform in nature. (b) Anterior segment OCT of patient’s left eye. There is central corneal thinning with diffuse stromal edema. Descemet’s membrane is focally detached (white arrow pointing to area of separation) with formation of a layered intracorneal hypopyon between the posterior stroma and detached Descemet’s membrane (blue arrow). (c) External slit-lamp photography of patient’s left eye after corneal perforation. (d) Pathology of cornea obtained at time of evisceration. There is acute necrotizing keratitis with epithelial thinning, subepithelial bullae and disruption of Bowman’s membrane, stromal necrosis and inflammation, diffuse loss of endothelium, and intracorneal hypopyon. Diffuse debris and gram-negative bacteria were also identified.

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