Endogenous panophthalmitis with orbital cellulitis secondary to Escherichia coli

Abstract

known causative agents of keratoconjunctivitis. AdV is commonly associated with a diffuse epithelial keratopathy, followed by the appearance of subepithelial corneal infiltrates, which may persist for months or years. In contrast, a stromal keratitis is predominantly related to infection with members of the herpesvirus family. In the absence of a history or evidence of a previous herpetic keratitis and an absence of herpes simplex virus 1, 2 in tear samples, it would be unlikely that both patients developed a concomitant herpetic keratitis. Given that AdV was still being shed in the tear film during the most severe period of the keratitis, and the subsequent clearance of the oedema following cessation of AdV shedding, would suggest that the stromal reaction and KPs were due to an immune reaction to virus within the corneal stroma. The onset of the stromal disease, that is, 2-3 weeks, is consistent with the development of an adaptive immune response. Increased activated dendritic cells in the epithelium and stroma is a well-established immune response in AdV keratoconjunctivitis. The increased severity of the stromal oedema and KPs in the second patient possibly reflects an enhanced immune response as a consequence of a previous episode of AdV keratitis. The development of centrally localized stromal oedema and KPs in the presence of coexistent subepithelial infiltrates, has, to our knowledge, not previously been reported in AdV keratoconjunctivitis and although rare should be considered in the differential diagnosis of viral stromal keratitis.