Endophthalmitis caused by Mycobacterium houstonense : case report
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CASE REPORT
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Endophthalmitis caused by Mycobacterium houstonense: case report Xin Che†, Qingjian Li†, Luoziyi Wang, Jing Jiang, Xuzhong Shen, Yiwen Qian* and Zhiliang Wang*
Abstract Background: Mycobacterium houstonense is rapidly growing mycobacteria (RGM) that belongs to M. fortuitum group. So far, there have been few associated reports of human diseases induced by M. houstonense worldwide. Case presentation: We present a delayed-onset postoperative endophthalmitis caused by M. houstonense after glaucoma drainage implant (GDI) surgery. The ocular infection lasted for 2 months without appropriate treatment that developed into endophthalmitis and the patient underwent an emergency enucleation. Conclusion: Implant erosion and a delay in diagnosis of ocular infection could lead to irreversible damage as observed in our case. Ophthalmologists should be alert for ocular RGM infection, and prompt laboratory diagnosis with initiation of effective multidrug therapy might prevent loss of vision. Keywords: Mycobacteria houstonense, Rapidly growing mycobacteria (RGM), Glaucoma drainage implant, Conjunctival erosion, Endophthalmitis
Background Currently, the species of rapidly growing mycobacteria (RGM) capable of producing disease in humans are grouped into six major taxonomic groups according to pigmentation and genetic relatedness. The major taxa are the Mycobacterium fortuitum group, M. chelonae/M. abscessus complex, M. smegmatis group, M. mucogenicum group, M. mageritense/M. wolinskyi, and the pigmented RGM. M. fortuitum group has historically included M. fortuitum, M. peregrinum, M. senegalense, M. porcinum, M. neworleansense, M. boenickei, M. houstonense, M. brisbanense, M. septicum, and M. setense [1]. Ocular infections caused by RGM are keratitis, scleritis, uveitis and endophthalmitis. The predisposing factors of ocular RGM infections include trauma, cataract surgery, intravitreal injection, corticosteroid use, endogenous endophthalmitis, glaucoma drainage implant (GDI) and systemic immunosuppression [2]. Endophthalmitis induced * Correspondence: [email protected]; [email protected] † Xin Che and Qingjian Li contributed equally to this work. Department of Ophthalmology, Huashan Hospital of Fudan University, No. 12, Middle Urumqi Road, Shanghai 200040, China
by RGM is an uncommon condition encountered post ocular surgery or trauma, which is sight threatening, may be acquired through contamination of water or antiseptic solutions. Most RGM endophthalmitis cases reported in the literature are exogenous, most of which occurred following cataract surgery [3, 4], multiple corneal transplantation [5, 6], intravitreal triamcinolone injection [7], ocular trauma [8], GDI surgery [9], silico ne-filled eye [10]. Here, we present a case of delayed-onset postoperative endophthalmitis caused by M. houstonense after GDI surgery. The device of GDI is used to drain aqueous humor from the anterior chamber of the eye into the subconjunctival or suprachoroidal space in order to lower the intraocular pressure in glauco
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