Recurrent Indolent Keratitis Caused by Achromobacter xylosoxidans: A Case Report and Literature Review.

An 83-year-old male with a history of radial keratotomy and laser-assisted in situ keratomileusis (LASIK) presented with symptoms of a non-resolving corneal ulcer in the right eye that had been present for five months. The patient was treated with antibacterial, antiviral, and antifungal medications over that period, with multiple recurrences that prompted referral to our tertiary center for management. Following a 48-hour cessation of all medications, a corneal biopsy was performed which grew Achromobacter xylosoxidans. In conclusion, Achromobacter xylosoxidans remains a rare cause of keratitis but should be considered in patients with a slow-progressing disease. Risk factors include previous corneal surgeries or trauma, topical steroid use, and contact lens wear. Because A. xylosoxidans grows slowly, it can have a deep impact on the cornea. To help antibiotics get into the cornea properly, epithelial debridement may be helpful. It does not respond to standard empiric antibiotic therapy. Ceftazidime and fourth-generation fluoroquinolones are better choices for treatment.