Title : A case of complicated polymicrobial keratitis in a patient of multiple myeloma and hyperthyroidism
Abstract:
Background: Multiple myeloma is a malignant plasma cell disorder that results in multiorgan dysfunction like skull lytic lesions fractures, space occupying lesions in frontal lobes with extracranial extension resulting in severe proptosis, renal failure, increased risk of infections, anemia, hyperviscosity syndromes. Hyperthyroidism is characterized by palpitations, muscle weakness, fatigue, weight loss, lid lag, hypermetabolic states.
Case presentation: A male patient of age 38 years presented with decreased vision for near distance associated with swelling and pain since two months.On examination severe bilateral proptosis, lid edema, lagopthalmos, conjunctival congestion, chemosis and mucoid discharge are present. On B scan hypoechoic mass lesions present in both eyes right more than left few calcification like spots in right eye lesions. On KOH/CFW mount LEFT EYE: Septate hyaline hyphae 0-2/HPF. Gram Stain: Polymorphs 0-5/OIF, Epithelial cells 0-2/OIF, Gram positive bacilli in v and l forms in short chains 0-3/OIF SEEN. Gram stain of right eye: Polymorphs:0-4/OIF, Epithelial cells 0-2/OIF, Gram positive bacilli 0-2/OIF SEEN. Following cultures Actinomyces and Aspergillus niger are grown based on sensitivity pattern fortified cefazolin 5% eye drops, fortified amikacin 2% eye drops, topical natamycin 5% eye drops along with tab itraconazole were given patient improved following medication.
Conclusion: Multiple myeloma Is a immunocompromised state which increases the risk of infections also when there is space occupying lesion in frontal lobes and extra cranial extension causing severe proptosis along with hyperthyroidism causing the lid lag corneal exposure to fungal spores increases the risk of fungal keratitis along with poor oral hygiene anaerobic bacteria can easily spread and cause intraorbital infections like keratitis.
