Case Report

Case Report: Recurrent Hypopyon after Penetrating Corneal Wound Complicated by a Staphylococcus Capitis Infection

by Iris Païdassi1, Benjamin Castel1, Deborah Lipski2, Elie Motulsky2*

1Ophthalmology Department of Saint-Jean Hospital (Brussels), Boulevard du Jardin Botanique 32, 1000 Bruxelles, Belgium

2Ophthalmology Department of the Erasme University Hospital (Brussels, ULB - Université Libre de Bruxelles), Route de Lennik 808, 1070 Bruxelles, Belgium

*Corresponding author: Elie Motulsky, Ophthalmology Department of the Erasme University Hospital (Brussels, ULB - Université Libre de Bruxelles), Route de Lennik 808, 1070 Bruxelles, Belgium

Received Date: 30 June 2023

Accepted Date: 04 July 2023

Published Date: 06 July 2023

Citation: Paidassi I, Castel B, Lipski D, Motulsky E (2023) Case Report: Recurrent Hypopyon after Penetrating Corneal Wound Complicated by a Staphylococcus Capitis Infection. Ann Case Report. 8: 1361. https://doi.org/10.29011/2574-7754.101361

Abstract

Purpose: Description of the management of recurrent inflammation with hypopyon in an ocular penetrating trauma complicated by a rare Staphylococcus Capitis infection.

Observations: We report the clinical case of a 40-year-old forest ranger who sustained a penetrating corneal wound with anterior lens impact caused by a plant. This patient subsequently developed recurrent inflammation with hypopyon, occurring remotely from the initial trauma as soon as local antibiotics were tapered. It was difficult to identify the cause (the first cultures being negative) and to control the inflammation despite re-introduction of antibiotic treatment. A sine lente phacoemulsification procedure finally allowed control of the infection, most likely by removal of the infectious lens focus. At the same time, new cultures came back positive for Staphylococcus Capitis. After secondary implantation of an intraocular lens, the patient regained full visual acuity.

Conclusions and Importance: To the best of our knowledge, this is the first report of Staphylococcus Capitis intraocular infection following a trauma in an adult. The right balance between medically and surgically treating a recurrent inflammation caused by a rare multi-susceptible Staphylococcus Capitis infection in a penetrating corneal wound associated with a traumatic cataract remains challenging. Doctors should closely monitor and be prepared to adapt their management to the clinical evolution. In traumas, prevention stays paramount.

Keywords: Recurrent Hypopyon; Recurrent Inflammation; Penetrating corneal wound; Infectious traumatic cataract; Vegetal trauma; Staphylococcus Capitis

Introduction

Corneal wounds are common and all too often preventable injuries with potentially significant visual sequelae. The management and visual prognosis depend on the type of injury. A systematic approach is therefore needed to identify the cause and adapt the treatment, especially when the trauma is complicated by infection or inflammation, the origin of which is often difficult to determine. Proper management requires prompt diagnosis, microbiological sampling to identify possible germs as soon as possible, and medical or surgical treatment depending on the size and nature of the wound. We present the case of a penetrating corneal wound by a hawthorn branch in a 40-year-old forest ranger with effraction of the anterior surface of the lens, which evolved into recurrent inflammation, the origin of which was difficult to diagnose and treat.

Figure 1: Left eye of our patient at presentation. Description: 1A Penetrating corneal wound in a paracentral-inferior location and 1B central impact in the anterior lens capsule highlighted by retroillumination.

Figure 2: Left eye of our patient, 3 weeks post initial trauma. Description : Presence of intraocular inflammation in the left eye with diffuse hyperaemia, a fluoropositive inferocentral corneal wound, a 1mm hypopyon, a 2-cell Tyndall in the anterior chamber and whitish deposits on the anterior lens capsule.