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Abiotrophia defectiva causing infectious crystalline keratopathy and corneal ulcer after penetrating keratoplasty: a case report

Yannis M Paulus14* and Glenn C Cockerham123

Author Affiliations

1 Department of Ophthalmology, Stanford University, Palo Alto, CA 94305, USA

2 Ophthalmology Section, Veterans Administration Palo Alto Health Care System, 3801 Miranda Avenue, Palo Alto, CA, 94304, USA

3 Department of Pathology, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA 94305-5324, USA

4 Byers Eye Institute, Stanford Hospital and Clinics, 2452 Watson Court, Palo Alto, Stanford, CA, 94303-5353, USA

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Journal of Ophthalmic Inflammation and Infection 2013, 3:20  doi:10.1186/1869-5760-3-20

Published: 25 January 2013



Infectious crystalline keratopathy is commonly caused by Streptococcus viridans and other gram positive organisms. We present the first case of infectious crystalline keratopathy that developed into a corneal ulcer and grew Abiotrophia defectiva which responded well to topical and systemic antimicrobial therapy and did not require re-grafting. A 78-year-old man underwent penetrating keratoplasty for pseudophakic bullous keratopathy. He presented 1.5 years later with infectious crystalline keratopathy which progressed to a corneal ulcer. The patient received topical fortified vancomycin and moxifloxacin, as well as oral moxifloxacin.


The corneal ulcer base was cultured and grew A. defectiva, or nutritionally deficient streptococcus. Complete resolution of the corneal infiltrates was obtained within three months.


Nutritionally deficient streptococcus has been implicated in numerous human diseases, including endocarditis, and is increasingly being recognized as an important pathogen. This represents the second reported case of A. defectiva causing infectious crystalline keratopathy in humans and the first case of A. defectiva successfully treated with antibiotics. This case shows that aggressive antibiotic therapy can be effective in A. defectiva-associated infectious crystalline keratopathy.

Abiotrophia defectiva; corneal ulcer; fastidious streptococcus; infectious crystalline keratopathy; nutritionally deficient streptococcus; penetrating keratoplasty