A 35-year-old lady, who worked in the royal stable, presented with redness and decreased vision in her right eye of 15 days duration. She was initially treated at a local health center for a corneal abrasion in her right eye, after being hit by the tail of a horse while cleaning the stable. She applied honey three times everyday to her painful right eye as advised by a local traditional healer. A week later, the pain in her eye decreased, but the vision in the right eye deteriorated and redness increased.\nAt the time of presentation, she had no pain or photophobia. The best corrected vision in the right eye was counting fingers at 2 m, and left eye was 0.5 with +2.0 D sph. The right eye showed ciliary congestion. A central corneal ulcer measuring (2 × 3 mm) in size with a hypopyon was noted. Culture of the scrapings from the ulcer grew dermatophytes on Sabouraud agar, which was identified as T. mentagrophytes. There was no evidence of superficial mycoses affecting skin, nails or any other area of her body.\nThe ulcer was treated with topical antifungal drops (Fluconazole 0.3%; Zocon® FDA Ltd) every hour, and cycloplegic (Cyclopentolate hydrochloride 1%; Mydrilate® Intrapharm) three times daily. Ten days following treatment, the patient underwent therapeutic keratoplasty for a non-healing corneal ulcer with impending perforation. The graft was clear and the eye quiet with a visual acuity of 0.2 on the first postoperative day. The topical medications were continued post-keratoplasty. However, the primary infection recurred involving the graft by the fourth postoperative day, progressing relentlessly to involve the entire graft by the 15th day resulting in a vascularized central scar by 2 months (). Posterior segment of the eye and the vitreous cavity appeared normal on B scan ultrasonography. Intra ocular pressure was 10 mmHg. The final visual acuity at the end of 2 months was appreciation of hand movements in the right eye.
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.