An Unexpected Culprit: Corneal Ulcer Caused by Streptococcus viridans
Abstract
Different types of organisms--viral, bacterial, fungal or parasitic--can cause corneal ulcers. Fungal corneal ulcers often present with feathery borders and satellite lesions, while bacterial ulcers often present with stromal edema and sometimes a hypopyon, and typically are more aggressive than fungal ulcers. In this case, a 54-year-old male presented to a small, rural ER in Virginia due to a right eye foreign body sensation. Conjunctival injection and fluorescein uptake from a corneal abrasion were present on exam. Erythromycin ointment was prescribed and follow-up with an ophthalmologist was arranged. The patient was unable drive to his follow-up appointment or pick up his ointment. Six days later, he presented again to the ER due to worsening eye pain. He had significant conjunctivitis with a small corneal infiltrate inferonasal to the pupil. He reported visual disturbance and blurry vision in his right eye. After transfer to Johnson City Medical Center, cultures and corneal scraping was performed. Eye cultures with plates grew two types of Streptococcus viridans (S. mitis and S. oralis); fungal scrapings showed no growth, and the Streptococcus species were suspected to be causative. This specific case is unusual because Streptococcus mitis and Streptococcus oralis are common skin flora and do not commonly cause corneal ulcers. JCMC’s microbiology lab suggested that these two bacterial species were the causative organisms of the ulcers because of their growth patterns on the plates. The patient was put on a systemic antifungal medication due to a high suspicion for fungal etiology originally, as well as fortified vancomycin and tobramycin compounded at JCMC. As the ulcer improved, the antifungal and fortified antibiotics were discontinued, and the patient was discharged on erythromycin and moxifloxacin; both bacterial species were susceptible to both medications. One week of oral acyclovir was given to cover for a viral etiology.
Start Time
15-4-2026 1:30 PM
End Time
15-4-2026 4:30 PM
Room Number
Culp Ballroom 316
Poster Number
24
Presentation Type
Poster
Presentation Subtype
Posters - Competitive
Presentation Category
Health
Student Type
Graduate and Professional Degree Students, Residents, Fellows
Faculty Mentor
Brent Aebi
An Unexpected Culprit: Corneal Ulcer Caused by Streptococcus viridans
Culp Ballroom 316
Different types of organisms--viral, bacterial, fungal or parasitic--can cause corneal ulcers. Fungal corneal ulcers often present with feathery borders and satellite lesions, while bacterial ulcers often present with stromal edema and sometimes a hypopyon, and typically are more aggressive than fungal ulcers. In this case, a 54-year-old male presented to a small, rural ER in Virginia due to a right eye foreign body sensation. Conjunctival injection and fluorescein uptake from a corneal abrasion were present on exam. Erythromycin ointment was prescribed and follow-up with an ophthalmologist was arranged. The patient was unable drive to his follow-up appointment or pick up his ointment. Six days later, he presented again to the ER due to worsening eye pain. He had significant conjunctivitis with a small corneal infiltrate inferonasal to the pupil. He reported visual disturbance and blurry vision in his right eye. After transfer to Johnson City Medical Center, cultures and corneal scraping was performed. Eye cultures with plates grew two types of Streptococcus viridans (S. mitis and S. oralis); fungal scrapings showed no growth, and the Streptococcus species were suspected to be causative. This specific case is unusual because Streptococcus mitis and Streptococcus oralis are common skin flora and do not commonly cause corneal ulcers. JCMC’s microbiology lab suggested that these two bacterial species were the causative organisms of the ulcers because of their growth patterns on the plates. The patient was put on a systemic antifungal medication due to a high suspicion for fungal etiology originally, as well as fortified vancomycin and tobramycin compounded at JCMC. As the ulcer improved, the antifungal and fortified antibiotics were discontinued, and the patient was discharged on erythromycin and moxifloxacin; both bacterial species were susceptible to both medications. One week of oral acyclovir was given to cover for a viral etiology.
