Abstract • Patients with human immunodeficiency virus infection are predisposed to fungal, parasitic, and viral infections. Bacterial infection can also be seen, although ocular bacterial infections have not been reported in patients with acquired immunodeficiency syndrome until recently. We present two cases of Pseudomonas corneoscleritis and one case of Pseudomonas keratitis in patients with human immunodeficiency virus infection that failed to respond to antibiotic treatment. Predisposing factors included extended-wear soft contact lens use in one patient and exposure secondary to Bell's palsy in another patient. All three patients had neutropenia that may have contributed to their poor response to treatment. Enucleation was required to treat two patients with overwhelming infection. Enucleation has been rarely required for treatment of corneoscleritis in immunocompetent patients treated at our institution. Pseudomonas keratitis in human immunodeficiency virus-infected patients represents a serious ocular infection requiring early diagnosis and aggressive treatment. References 1. Fahey JL. Immunologic alterations . Ann Intern Med . 1983;99:208-220.Crossref 2. Macher AM. Infection in the acquired immunodeficiency syndrome . Ann Intern Med . 1984;100:92-106.Crossref 3. Lane HC, Masur H, Edgar LC, Whalen G, Rook AH, Fauci AS. Abnormalities of B-cell activation and immunoregulation in patients with the acquired immunodeficiency syndrome . N Engl J Med . 1983;309:453-458.Crossref 4. Ammann AJ, Schiffman G, Abrams D, Volberding P, Ziegler J, Conant M. B-cell immunodeficiency in acquired immunodeficiency syndrome . JAMA . 1984;251:1447-1449.Crossref 5. Pahwa SG, Quilop MTJ, Lange M, Pahwa RN, Grieco MH. Defective B-lymphocyte function in homosexual men in relation to the acquired immunodeficiency syndrome . Ann Intern Med . 1984;101:757-763.Crossref 6. Whimbey E, Gold JWM, Polsky B, et al. Bacteremia and fungenous in patients with the acquired immunodeficiency syndrome . Ann Intern Med . 1986;104:511-514.Crossref 7. Witt DJ, Craven DE, McCabe WR. Bacterial infections in adult patients with the acquired immunodeficiency syndrome (AIDS) and AIDS-related complex . AmJ Med . 1987;82:900-906.Crossref 8. Davis JL, Nussenblatt RB, Bachman DM, Chan CC, Palestine AG. Endogenous bacterial retinitis in AIDS: report of two cases . Am J Ophthalmol . 1989;107:613-623. 9. Shuler JD, Engstrom RE, Holland GN. External ocular disease and anterior segment disorders associated with AIDS . Int Ophthalmol Clin . 1989;29:98-104.Crossref 10. Baum JL, Jones DB. Initial therapy of suspected microbial corneal ulcers, I: broad antibiotic therapy based on prevalence of organism; II: specific antibiotic therapy based on corneal smears . Surv Ophthalmol . 1979;24:97-105, 106-116.Crossref 11. Codere F, Brownstein S, Jackson WB. Pseudomonas aeruginosa scleritis . Am J Ophthalmol . 1981;91:706-710. 12. Raber IM, Laibson PR, Kurz GH, Bernardino VB. Pseudomonas corneoscleral ulcers . Am J Ophthalmol . 1981;92:353-362. 13. Eiferman RA. Cryotherapy of Pseudomonas keratitis and scleritis . Arch Ophthalmol . 1979;97:1637-1639.Crossref 14. Alfonso E, Kenyon KR, Ormerod LD, Stevens R, Wagoner MD, Albert DA. Pseudomonas corneoscleritis . Am J Ophthalmol . 1987;103:90-98. 15. Farrell PLR, Smith RE. Bacterial corneoscleritis complicating pterygium excision . Am J Ophthalmol . 1989;107:515-517. 16. Centers for Disease Control. Revision of the CDC surveillance case definition of acquired immunodeficiency syndrome . MMWR . 1987;36:1S-15S.
Archives of Ophthalmology – American Medical Association
Published: Apr 1, 1991