PMC10220441_01
Slit-lamp image of (a) ring-shaped infiltrate in the right eye on presentation, (b) resolving to infiltrate at 1 week, (c) scarring infiltrate with mild corneal edema at 2 weeks, (d) completely scarred infiltrate at 1 month, (e) recurrence of anterior uveitis with inflammatory hypopyon at 4 months, (f) resolution of uveitis after steroid treatment, (g) paracentral stromal infiltrate of the left eye at 1 week, (h) granulomatous uveitis at 2 weeks, and (i) resolution of uveitis on steroid therapy at 1 month
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F1
The anterior chamber was quiet with no hypopyon and the lens was phakic [Figure 1a]. Ocular examination showed a resolving corneal infiltrate with no epithelial defect and BCVA improved to 20/200 in the right eye [Figure 1b]. Slit-lamp examination showed a scarring ring infiltrate in the right eye with mild corneal edema [Figure 1c]. There was a paracentral stromal infiltrate measuring 2 mm x 2 mm with no epithelial defect, quiet AC, and no hypopyon in the left eye [Figure 1g]. One week later, the patient came for a follow-up which revealed scarred infiltrate in the right eye [Figure 1d] and diffuse stromal edema, granulomatous keratic precipitates (KPs), and 3+ cells in AC in the left eye [Figure 1h]. On the 2-week follow-up, her BCVA improved to 20/20 in both eyes with scarred infiltrate and quiet AC bilaterally [Figure 1d and i]. The patient was doing well when 4 months later; she again had a similar episode of uveitis in the right eye [Figure 1e]. Hence, a possibility of recurrent uveitis secondary to endogenous infection was kept and was successfully treated with a short course of topical steroids [Figure 1f].
(a) Gram stain of the right eye showing Gram-negative bacilli, (b) white mucoid colonies of Klebsiella pneumoniae on blood agar, and (c) lactose-fermenting colonies of Klebsiella pneumoniae on MacConkey agar
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F2
Gram stain of corneal scrapings revealed Gram-negative rods and culture yielded heavy growth of K. pneumoniae [Figure 2] later identified as ESBL producers by VITEK (automated method for antibiotic sensitivity testing).
Fundus photograph at 1-week follow-up with normal optical coherence tomography scans of the right eye (a and c) and left eye (b and d)
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F3
Her fundus examination was normal on all the visits [Figure 3].