Case 2

The worried mother of a 7-month-old male calls the pediatric clinic after her son woke up with a red left eye. The child had been swimming in a pool almost daily for more than a week. On examination, the child’s eye had purulent discharge but the examination was difficult, with a poor view of the eye. The health care provider prescribed erythromycin ophthalmic ointment twice daily.

The next day, there was no improvement in the child’s conjunctival injection or discharge. The mother called the provider and was advised to continue the erythromycin ointment for 1 more day. By day 3, there was no improvement and possible worsening of the child’s symptoms. The primary care provider then referred the child to an ophthalmologist. The ophthalmologist also had difficulty examining the boy’s eye but discontinued the erythromycin ointment and initiated treatment with a newer fluoroquinolone eye drop 3 times per day.

However, by day 4 the child had still not improved so the mother returned to the ophthalmologist, who was able to get a better examination and diagnosed the boy with a corneal ulcer, likely caused by Pseudomonas aeruginosa. Treatment was escalated to a newer fluoroquinolone drop every 30 minutes for 36 hours followed by one drop every hour for 48 hours. The infection resolved and the ulcer eventually healed.

Commentary
Exposure to contaminated water in heated swimming pools can lead to conjunctivitis caused by P aeruginosa, and a failure in clinical response to any therapy selected should prompt re-examination and reconsideration of treatment.¹

References

1. Zichichi L, Asta G, Noto G. Pseudomonas aeruginosa folliculitis after shower/bath exposure. Int J Dermatol. 2000;39(4):270-273.