Marques-Couto Pedro, Gama-Castro Ana, Carvalho Teresa, Vilares-Morgado Rodrigo, Pinheiro-Costa João, Pinheiro Dolores, Cunha Ana Maria
Department of Ophthalmology, Unidade Local de Saúde de São João, Porto, Portugal.
Laboratory of Microbiology, Department of Clinical Pathology, Unidade Local de Saúde de São João, Porto, Portugal.
IDCases. 2025 Feb 3;39:e02176. doi: 10.1016/j.idcr.2025.e02176. eCollection 2025.
Acute hydrops is a characteristic complication of corneal ectatic diseases. While is known to cause various ophthalmic infections, most commonly following surgery, there are no reported cases of infection by this microorganism in the context of acute hydrops, nor concurrent with infection.
A 33-year-old Portuguese woman of Caucasian ethnicity with a history of keratoconus presented with a red eye and ocular discomfort in the right eye at the Ophthalmology Emergency Department. Initial examination revealed acute hydrops with no epithelial defects nor signs of infection. Posteriorly, she developed dendritic epithelial lesions suggestive of virus infection. These lesions progressed, leading to a central corneal infiltrate and descemetocele. Due to perforation of the descemetocele, a tectonic penetrating keratoplasty was successfully performed, and coinfection of and was later confirmed through microbiological examination.
This is the first reported case of corneal coinfection with and in the setting of acute hydrops. The combination of corneal edema, previous viral infection, and prolonged corticosteroid use likely created a "perfect storm" scenario, predisposing the patient to this unusual coinfection. Our findings highlight the need for heightened awareness of atypical infections in patients with acute hydrops and suggest that such complications may alter corneal barrier function. This case contributes to the understanding of complex interactions between corneal conditions and microbial infections.
急性水肿是角膜扩张性疾病的一种典型并发症。虽然已知该病原体可引起各种眼部感染，最常见于手术后，但在急性水肿的情况下，尚无该微生物感染的报道病例，也没有与该病原体感染同时发生的情况。
一名33岁的葡萄牙白人女性，有圆锥角膜病史，因右眼眼红和眼部不适就诊于眼科急诊科。初步检查显示急性水肿，无上皮缺损及感染迹象。后来，她出现了提示病毒感染的树枝状上皮病变。这些病变进展，导致中央角膜浸润和后弹力层膨出。由于后弹力层膨出穿孔，成功进行了结构性穿透性角膜移植术，随后通过微生物学检查证实了与该病原体的混合感染。
这是首次报道在急性水肿情况下角膜与该病原体混合感染的病例。角膜水肿、既往病毒感染和长期使用皮质类固醇的综合作用可能造成了一种“完美风暴”的情况，使患者易发生这种不寻常的混合感染。我们的研究结果强调，对于急性水肿患者，需要提高对非典型感染的认识，并提示此类并发症可能改变角膜屏障功能。该病例有助于理解角膜疾病与微生物感染之间的复杂相互作用。
