Atypical Presentation Of Scleritis And Subconjunctival Abscess: A Rare Ocular Manifestation Of Melioidosis

Ocular manifestations of melioidosis are relatively rare. Despite the high incidence of melioidosis in Thailand, there is only one large retrospective study on ocular melioidosis, which identified 16 cases over a 23-year period (Between 1993 and 2016). When focusing specifically on anterior segment ocular infections, only five cases of corneal ulcers and sclerokeratitis caused by Burkholderia pseudomallei have been reported in Thailand. Therefore, clinical evaluation, management and prognosis remain inconclusive due to limited of data available.This report may provide a framework for initial evaluation, along with treatment strategies for ocular melioidosis.

Department of Ophthalmology, Faculty of Medicine, Thammasat University Hospital

This report describes a 52-year-old Thai female presenting with pain around the right eye and abdominal pain. Her visual acuity had declined, violaceous nodule and subconjunctival abscess was observed. She was diagnosed with disseminated melioidosis, involving infectious scleritis with a subconjunctival abscess and a psoas abscess. Subconjunctival abscess culture identified Burkholderia pseudomallei. The patient was treated by Incisional and drainage including debridement the necrotic friable tissue of sclera along with subconjunctival Ceftazidime injection every 3 days for 3 doses. Additionally, fortified topical Ceftazidime eye drops were administered every 2 hours, and intravenous Ceftazidime 2 grams every 8 hours were given for 3 weeks.

After 3 week, the ocular picture lesion and psoas abscess showed significant improvement. The antibiotic regimen was tapered to Trimethoprim + Sulfamethoxazole (80/400 mg), 3 tablets twice daily, including fortified topical Ceftazidime eye drops 4 times daily, duration for 3 months. After completing the full course of antibiotics, no signs of recurrence were observed.

Due to the rarity and nonspecific presentation of ocular melioidosis, the reported incidence of cases may be lower than the actual number, as patients often present with severe systemic infections or involvement of other organs which may require more urgent attention than the ocular issue. However, ocular melioidosis still requires specific systemic and ocular antibiotics for treatment, and adjunctive scleral debridement may also be necessary. Ophthalmologists should be aware of the condition and work to identify the pathogen in order to ensure appropriate management