Corneal Anterior and Posterior Changes in a Patient With Keratitis Associated With Mycobacterium chelonae: A Case Report.

Purpose: This report describes a patient with anterior and posterior corneal topographic changes who developed refractory keratitis due to Mycobacterium chelonae, associated with soft contact lens use.

Case: A 42-year-old man presented with blurred vision and pain in his right eye. He used disposable soft contact lenses for 2 weeks with appropriate care. He had open-angle glaucoma, atopic dermatitis, and diabetes mellitus. At the initial presentation, a corneal epithelial defect, cell infiltration, strong hyperemia, hypopyon, and inflammation in the anterior chamber were observed. Anterior segment optical coherence tomography disclosed corneal edema and cloudiness, and the central corneal thickness had increased to 988 μm. The best-corrected visual acuity was counting fingers at 10 cm. The patient did not respond to the initial treatment with ofloxacin and steroids. The culture of the scraped sample from the contact lens case grew M. chelonae, and topical tobramycin was administered, which was effective based on antimicrobial susceptibility. It took 4 months to treat the keratitis, and the best-corrected visual acuity improved to 0.5, although anterior and posterior corneal irregularities remained.

Conclusion: Nontuberculous M. chelonae should be considered in patients with treatment-resistant keratitis, especially in contact lens users. Topographic changes are important for evaluating corneal edema and irregular astigmatism, which impair visual function after keratitis.