A 56-year-old female was referred to King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia, with central corneal thinning in her left eye and a scar. She reported a painless decrease in vision following the self-application of alum substances to her left eye for eye redness and discomfort. There was no history of previous trauma, surgery, or any ophthalmic disorder. There was no history of any systemic illness or use of any systemic or topical medications. Ophthalmic examination indicated the best-corrected visual acuity of 20/20 in the right eye (OD) and counting fingers at 1 m in the left eye (OS). Intraocular pressure measured with applanation tonometry was within the normal range bilaterally. Examination of the right eye was unremarkable except for a mild cataract. Slit-lamp examination of the left eye indicated a quiet conjunctiva and central corneal scar with no corneal epithelial defect; there was corneal thinning without descemetocele, nuclear sclerosis, and a hazy view of the fundus []. B-scan ultrasonography OS indicated no pathology at the posterior pole. The alum substance was analyzed using scanning electron microscope (SEM) and revealed the elements shown in .
A 35-year-old Pakistani male with a history of chronic malaria, progressive splenomegaly and a complaint of severe left sided abdominal pain was treated by branding with a hot metal rod 7 days prior to admission. A week later he was admitted for septic shock and severe pain in the left hypochondrium. Past medical history was noncontributory except for an intermittent low-grade fever and occasional spikes of a high-grade fever with chills. On examination, he was disoriented and had multiple circular full-thickness burns to the anterior abdomen ranging in size from 2 to 5 cm across with central sparing of the skin and yellow discharge from the wounds. Blood and wound cultures grew Staphylococcus aureus. Abdominal ultrasound on admission showed a massively enlarged spleen with multiple rounded areas of complex echogenicity showing multiple splenic abscesses which were not seen in previous ultrasounds. He was treated with broad spectrum antibiotics and silver sulfadiazine. A splenectomy was performed and a gross examination confirmed the existence of multiple splenic abscesses which were also positive for Staph. aureus. Culture of pus from the spleen revealed growth of same Staph. aureus that were present on burn wounds complicated by skin branding. The patient died in the fourth week during the course of treatment.