JKOS Journal of the Korean Ophthalmological Society J Korean Ophthalmol Soc 0378-6471 2092-9374 Korean Ophthalmological Society 10.3341/jkos.2014.55.6.918 jkos-55-918 Case Report A Case of Corneal Ulcer Caused by Leclercia Adecarboxylata LeeKee I1 MD ChungSung Kun MD, PhD HwangHyung Bin MD Department of Ophthalmology and Visual Science, The Catholic University of Korea College of Medicine, Seoul, Korea Address reprint requests to Hyung Bin Hwang, MD, Department of Ophthalmology, The Catholic University of Korea, Yeouido ST. Mary's Hospital, #10 63-ro, Yeongdeungpo-gu, Seoul 150-713, Korea, Tel: 82-2-3779-1243, Fax: 82-2-761-6869, E-mail: leoanzel@catholic.ac.kr 08 2014 30 08 2014 55 6 918 922 30 08 2013 10 12 2013 30 04 2014 Copyright © The 2014 Korean Ophthalmological Society 2014 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Purpose

To report a case of corneal ulcer caused by Leclercia adecarboxylata in an immunocompetent patient.

 Case summary

A previously healthy 43-year-old female presented with right ocular pain and was referred to our clinic under the impression of corneal abrasion and secondary infection. The patient was treated at a local clinic for 3 days using artificial tears, therapeutic contact lens, topical antibiotics, and anti-inflammatory eye drops but showed no improvement. Gram staining, bac-terial and fungal cultures and antibiotic sensitivity test were performed from a corneal scrape. The cultures revealed growth of Leclercia adecarboxylata. The patient was treated with moxifloxacin and ofloxacin eye drops. After 2 weeks of treatment, the in-fection resolved without remaining scars.

 Conclusions

Reportedly, Leclercia adecarboxylata affects humans only as an opportunistic pathogen or part of polymicrobial infections. However, in the present case, Leclercia adecarboxylata was isolated as a single pathogen in an immunocompetent patient which is the first clinical report of this microorganism found in an ocular sample. Therefore, if antibiotic-susceptible gram-negative bacilli are found in op-thalmologic samples, the above bacteria should be considerd in the diagnosis.

 Corneal ulcer Gram-negative bacilli Leclercia adecarboxylata References LeclerHEtude biochemique d'enterobacteriaceae pigmenteesAnn Inst Pasteur196210272641 RichardCNew Enterobacteriaceae found in medical bacteriology Moellerella wisconsensis, Koserella trabulsii, Leclercia adecarbox-ylata, Escherichia fergusonii, Enterobacter asbutiae, Rahnella aquatilisAnn Biol Clin (Paris)1989472316 TamuraKSakazakiRKosakoYYoshizakiELeclercia ade-carboxylata gen. nov., comb. nov., formerly known as Escherichia adecarboxylataCurr Microbiol19861317984 HwangHYJeongSHRimHA case of Leclercia adecarbox-ylata isolated from dialysate in a patient with continuous ambula-tory peritoneal dialysisKorean J Clin Microbiol199811136 MazzariolAZulianiJFontanaRCornagliaGIsolation from blood culture of a Leclercia adecarboxylata strain producing an SHV-12 extended-spectrum beta-lactamaseJ Clin Microbiol20034117389 DalamagaMPantelakiMPapadavidEEpididymo-orchitis and bacteremia caused by Leclercia adecarboxylataMed Mal Infect2008386745 DalamagaMPantelakiMKarmaniolasKIsolation of Leclercia adecarboxylata from blood and burn wound after a hy-drofluoric acid chemical injuryBurns2009354435 DavenportPLandKJIsolation of Leclercia adecarboxylata from the blood culture of an asymptomatic platelet donorTransfusion20074718169 SawamuraHKawamuraYYasudaMA clinical isolate of Leclercia adecarboxylata from a patient of pyelonephritisKansenshogaku Zasshi2005798315 BeltránAMolineroAVCapillaSIsolation of Leclercia ade-carboxylata from wound exudate of a diabetic patientMed Clin (Barc)2004122159 Pérez-MorenoMOAngueraJCarullaMPérez-MorenoMSeptic arthritis due to Leclercia adecarboxylata of probable iatro-genic originEnferm Infecc Microbiol Clin2003211678 Jover-SáenzACerezo-EsforzadoEBarcenilla-GaiteFLeclercia adecarboxylata cholecystitis in a patient with metabolic syndromeSurg Infect (Larchmt)200894112 RodríguezJASánchezFJGutiérrezNBacterial peritonitis due to Leclercia adecarboxylata in a patient undergoing peritoneal dialysisEnferm Infecc Microbiol Clin2001192378 LonghurstCAWestDCIsolation of Leclercia adecarboxylata from an infant with acute lymphoblastic leukemiaClin Infect Dis2001321659 de BaereTWautersGHuylenbroeckAIsolations of Leclercia adecarboxylata from a patient with a chronically in-flamed gallbladder and from a patient with sepsis without focusJ Clin Microbiol20013916745 FattalODevilleJGLeclercia adecarboxylata peritonitis in a child receiving chronic peritoneal dialysisPediatr Nephrol2000151867 TemesgenZToalDRCockerillFR3rdLeclercia adecarboxylata infections: case report and reviewClin Infect Dis1997257981 LeeNYKiCSKangWKHickman catheter-associated bac-teremia by Leclercia adecarboxylata and Escherichia hermannii: a case reportKorean J Infect Dis19993116770 BaliRSharmaPGuptaKNagrathSPharyngeal and peritonsillar abscess due to Leclercia adecarboxylata in an immunocompetant patientJournal of Infection in Developing Countries201374650 DazaRMIborraJAlonsoNIsolation of Leclercia ade-carboxylata in a cirrhotic patientEnferm Infecc Microbiol Clin199311534 OldenburgCELalithaPSrinivasanMMoxifloxacin sus-ceptibility mediates the relationship between causative organism and clinical outcome in bacterial keratitisInvest Ophthalmol Vis Sci20135415226 SharmaNGoelMBansalSEvaluation of moxifloxacin 0.5% in treatment of nonperforated bacterial corneal ulcers: a randomized controlled trialOphthalmology201312011738 KimMJYuFAldaveAJMicrobial keratitis after Boston Type I keratoprosthesis implantation: incidence, organisms, risk factors, and outcomesOphthalmology2013120220916 HessBBurchettAHuntingtonMKLeclercia adecarboxylata in an immunocompetent patientJ Med Microbiol2008578968 StockIBurakSWiedemannBNatural antimicrobial suscepti-bility patterns and biochemical profiles of Leclercia adecarbox-ylata strainsClinical Microbiology and Infection20041072433 FerrariTMLeozappaMLorussoMEscherichia coli kerati-tis treated with ultraviolet A/riboflavin corneal cross-linking: a case reportEur J Ophthalmol200919295297 Figures and Tables

(A) Anterior segment photograph at the first oph-thalmic examination showing a corneal ulcer with deep stromal infiltrations and linear hypopyon. (B) Corneal ulcer with de-creased stromal infiltration and remaining hypopyon on the 2nd day of antibacterial treatment. (C) Nearly regressed corneal ul-cer on the 7th day of antibacterial treatment.

(A) Anterior segment photograph (Fluorescein dye stained) on the 3rd day after starting anti-bacterial treatment; better marginated corneal ulcer with decreased stromal infiltration. (B) Anterior segment photograph (Fluorescein dye stained) on the 5th day showing decreased epithelial defects with remnant bacterial collections at the inferior cornea.