Hyperacute Gonococcal Keratoconjunctivitis

Excerpt

A sexually active 37-year-old man presented with 1 week of rapidly worsening eye pain unimproved with antibiotic drops. Exam revealed bilateral copious mucopurulent discharge that reappeared within minutes of wiping (Fig. 1), lid edema, conjunctival chemosis, complete right corneal “melting,” and left full-thickness perforating ulcerations. Parenteral ceftriaxone and every hour moxifloxacin drops were started and he emergently underwent bilateral ophthalmologic salvage surgery. Intracellular gram-negative diplococci on gram stain grew Neisseria gonorrhoeae (Fig. 2). Though otherwise asymptomatic, a urethral sample was positive for gonococcal urethritis. After weeks of therapy, including full-thickness corneal transplant, vision was 20/30 in the left eye and light perception only in the right.

…