Preseptal cellulitis caused by Acinetobacter lwoffi

Preseptal cellulitis caused by Acinetobacter lwoffi

Mathews Divya, Mathews John P, Kwartz Jeff, Inkster Clare Department of Ophthalmology, Bolton Hospital NHS Trust, Bolton, United Kingdom

Correspondence Address: Mathews Divya Department of Ophthalmology, Bolton Hospital, NHS Trust, Minerva Road, Farnworth, Bolton, BL4 0JR United Kingdomdiv_doc@hotmail.com

Indian Journal of Opthalmology

Acinetobacter sp. are gram-negative bacteria that are commonly present in soil and water as free living saprophytes and are also isolated as commensals from the skin, throat and various secretions of healthy people. We treated a patient who had clinical signs of allergic conjunctivitis who was eventually found to have culture proven Acinetobacter calcoaceticus ar Lwoffi causing preseptal cellulitis.

A fifty-year old male Caucasian with no previous ocular history of infection, trauma, contact lens wear or medical problems was seen in the emergency clinic with a one-day history of painful swelling around the right eye. He gave no history of foreign body getting into the eye or any exposure to known allergens. On examination, he was afebrile. His visual acuity in each eye was 6/6. There was nontender periorbital oedema, conjunctival chemosis and papillary conjunctival reaction [Figure - 1]. There was no focus of infection in the adnexa of the right eye. The rest of the anterior segment was normal. Fundoscopy was normal and ocular motility was full. The left eye was unaffected. An initial diagnosis of allergic conjunctivitis was made and he was started on oral antihistamines and artificial tears. He showed no improvement during the next twenty-four hours during which time he developed conjunctival discharge. A conjunctival swab was taken from his right eye and chloramphenicol eye drops were applied simultaneously with the clinical diagnosis of bacterial conjunctivitis. On the third day, he presented with severe pain around the right periorbital region with no appreciable clinical improvement. Preauricular nodes on the right side were enlarged, but nontender. He was afebrile with vision of 6/6 in each eye and equally reactive pupils and full ocular movements. Microscopic examination showed no organism. Cultures on solid media including blood agar (aerobic) and chocolate agar (anaerobic) revealed 15-20 colonies of Acinetobacter calcoaceticus var Lwoffi, sensitive to g. amoxicillin and g.ofloxacillin and resistant to g.chloramphenicol. There were no other isolates from the swab. CT scan of the orbits showed soft tissue swelling in the right periorbital region consistent with preseptal cellulitis. The application of chloramphenicol eye drops was withdrawn and a combination of oral amoxicillin and clavulanic acid and ofloxacillin eye drops was administered. The infection resolved completely in two weeks.

Acinetobacter calcoaceticus var Lwoffi is a gram negative, non fermentative, aeroebic rod, ubiquitous in nature, a common part of human flora and an opportunistic pathogen.[1] A. calcoaceticus var Lwoffi isolated in the present case is an unusual case of preseptal cellulitis.

Fortunately, this patient recovered completely with no ocular or life-threatening complication with the appropriate medical therapy. A. calcoaceticus Lwoffi has been reported to cause trauma-induced endopthalmitis[2] and infectious crystalline keratopathy.[3]

To the best of our knowledge, this is the first case of preseptal cellulitis caused by A. calcoaceticus Lwoffi to be reported and should be considered as a causative agent in the differential diagnosis of preseptal cellulitis induced by gram negative organisms.