Abstract

Background: This study reported a case of fulminant Sphingomonas paucimobilis keratitis in a patient with significant ocular and systemic comorbidities.
Case Presentation: A 73-year-old male with poorly controlled Type 2 diabetes and chronic bullous keratopathy presented with a central corneal ulcer. The clinical course was aggressive, and a hypopyon developed within four days despite broad-spectrum empirical treatment with cefazolin and ceftazidime. Microbiological investigation identified S. paucimobilis. Susceptibility testing revealed resistance to both third-generation cephalosporins and fluoroquinolones. The isolate was sensitive to amikacin. Therapy was adjusted to fortified amikacin and vancomycin. The infection resolved rapidly following the change in antibiotics. The patient subsequently developed a massive corneal scar, and B-scan showed signs of choroidal detachment. A therapeutic penetrating keratoplasty (TPK) with IOL explantation was performed to preserve globe integrity. However, the final visual outcome was limited to light perception due to graft failure.
Conclusion: Sphingomonas paucimobilis can exhibit aggressive behavior in compromised corneas. Pre-existing bullous keratopathy and uncontrolled diabetes are significant risk factors for severe disease. This case emphasized the increasing prevalence of antibiotic resistance in this organism. Early microbiological cultures and susceptibility-guided therapy are essential to prevent perforation and preserve globe integrity.

Key words: Sphingomonas paucimobilis, microbial keratitis, bullous keratopathy, diabetes mellitus, corneal ulcer, case report