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Mycobacterium abscessus subsp. bolletii keratitis: rare case reported in Brazil

Publicação: 10 de fevereiro de 2020

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Mycobacterium abscessus subsp. bolletii keratitis: rare case reported in Brazil The patient was admitted to the hospital and corneal scraping was performed for bacterioscopy, bacterial culture, culture for fungi, bacilloscopy, culture for mycobacteria and for direct research techniques1 . The patient was prescribed pimaricin (5%) every 1 h, acetazolamide (250 mg) (Diamox®) every 6 h, and atropine (1%), timolol maleate (0.5%), brimonidine tartrate (0.2%), and oral ciprofloxacin (750 mg) every 12 h. The laboratory findings showed negative results for bacterioscopy and bacilloscopy, positive bacteriological culture for Bacillus sp., negative assay and culture for fungi, and positive culture for mycobacteria. The bacterial colony, described as Bacillus sp according to identification by Vitek 2®, was atypical on blood agar and therefore, the material was cultivated in Lowestein Jensen solid medium, where the growth of characteristic mycobacterium colony was confirmed after visualization of acid-fast bacilli by Ziehl Neelsen staining. The organism was identified as Mycobacterium abscessus subsp. bolletii using the hsp65 -PRA technique1 . For the treatment of NTM, the patient was prescribed ciprofloxacin hydrochloride (3.5 mg/g) ointment every 6 h and oral clarithromycin (500 mg) every 12 h for 18 months, fortified vancomycin (2.5%) eye drops for 4 months and fortified gentamicin (1.2%) eye drops for 5 months. After 14 months of treatment, the result of conjunctival lavage culture for mycobacteria was negative. The patient showed progressive improvement, superior and inferior corneal neovascularization, hypopyon regression, reduction of infiltrate and edema with leukoma formation, epithelization and reduction of intraocular pressure, and 20/40 VA with pinhole for the LE at the end of the treatment ( Figure 1 ). http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0036-46652020000100503&lng=en&nrm=iso&tlng=en

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