NYMC Faculty Publications


Corneal Ulcer in a Patient With Severe Rheumatoid Arthritis: An Unusual Route

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PURPOSE: To report a case of Streptococcus mitis oralis () corneal ulcer in a patient with a possible preventable cause. METHODS: Cultures were obtained from a 64-year-old woman with a 3.5 mm × 5 mm corneal ulcer with hypopyon in the left eye. RESULTS: Culture reports demonstrated the growth of S, a commensal organism of the oral flora. Fortified vancomycin 5% eye drops were started, and the patient was counseled on the rarity of the bacteria as an etiology of corneal ulcers. On the return visit, the patient, who works in a doctor's office, volunteered information that the preservative free artificial tear vials that she used were difficult to open because of her hand deformity due to rheumatoid arthritis; thus, she had to bite the vials open. CONCLUSIONS: is an organism commonly found in the mouth but is rarely found in the eye. We report a unique case of an immunocompromised patient with rheumatoid arthritis, severe dry eye, and a history of multiple episodes of keratolysis, who developed a corneal ulcer from a rare pathogen, with a plausible and preventable route of infection.