Iris root abscess and necrotizing sclerokeratitis caused by Mycobacterium abscessus and presenting as hemorrhagic anterior uveitis.

PURPOSE: To report a case of an iris abscess and necrotizing sclerokeratitis caused by Mycobacterium abscessus and presenting as hemorrhagic uveitis. METHODS: An 86-year-old white woman was diagnosed with hemorrhagic anterior uveitis and treated with high-frequency topical steroids. The inflammation progressed to involve the cornea and the sclera, and the treatment was changed to intensive antibiotics. There was no improvement. Direct microscopy of a biopsy specimen of the lesion wrongly identified Nocardia as the cause, but antibiotic sensitivity suggested clarithromycin as a suitable therapeutic agent. Therapy was changed but there was continued deterioration. The eye could not be saved and the causative organism was subsequently discovered to be M. abscessus. RESULTS: The eye was enucleated 6 months after initial presentation. CONCLUSIONS: Ocular infection with M. abscessus is an extremely rare cause of necrotizing sclerokeratitis and may present as a hemorrhagic uveitis. There is a high risk of misdiagnosis and late detection, which may have severe consequences.

Clinical resolution of Brucella canis-induced ocular inflammation in a dog.

A 2-year-old spayed female mixed-breed dog was referred with an 8-month history of recurrent bilateral anterior uveitis and hyphema secondary to infection with Brucella canis. Treatment with doxycycline PO and atropine and prednisone acetate topically prior to referral had failed to resolve the ocular inflammation. Successful control of ocular inflammation was achieved after initiation of treatment with gentamicin SC and ciprofloxacin and doxycycline PO. The finite indirect fluorescent antibody (IFA) titer was reduced by half, and results of an agar gel immunodiffusion (AGID) test became negative after rifampin was added to the treatment protocol. Treatment with gentamicin was eventually discontinued because of evidence of renal toxicosis and cutaneous reactions to repeated injections. Thirty-five months after initial examination of the dog, results of the AGID test were still negative, the finite IFA titer was stable, and ocular inflammation had resolved, suggesting that the ocular infection may have been eliminated. To our knowledge, this represents the first report of the successful treatment of ocular inflammation caused by B canis infection in a dog.

The effect of sodium chloride extract and commercial lipopolysaccharides of Escherichia coli and Salmonella typhimurium on chickens.

In chickens inoculated into the heart with a sodium chloride extract of Escherichia coli strain (serotype O2) isolated from a chicken with colibacillosis, characteristic hemorrhages into the anterior chamber of the eyes (hyphema) were found. Significant lesions were limited to the eyes. Cyclophosphamide-treated chickens were more sensitive to the extract than untreated chickens and hyphema was usually seen in association with hemorrhages of the iris. These activities were not reduced by heating the extract at 60 degrees C for one hour or by trypsin digestion. Chickens inoculated into the heart with commercial lipopolysaccharides of E. coli (serotypes O111:B4 and O55:B5) and Salmonella typhimurium showed similar lesions in the eyes as the chickens inoculated with the sodium chloride extract. These findings suggest that the endotoxin may induce hyphema in chickens.