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 25-year-old Pakistani male with chronic liver disease (Hepatitis C positive) underwent branding of the anterior abdomen with a heated metal rod for severe pain (Figure ). One week later, he presented with altered mental status, high grade fever and multiple round circumscribed erythematous and indurated lesions on his abdomen ranging in size from 3 to 5 cm with black eschar and active drainage. His past medical history was noncontributory except for hepatitis C, diagnosed 10 years earlier. Ultrasound of the abdomen showed massive free fluid with splenomegaly and a shrunken liver. The ascitic fluid had a high white cell count (16,000/mm3) with 95% neutrophils. He was treated with a 3-week course of intravenous ceftriaxone and topical silver sulfadiazine and sterile dressings for 2 weeks. The fact that this was the first presentation with hepatic encephalopathy after branding, and pan sensitive E. Coli grew both from the branding inflicted skin wounds and ascitic fluid, points towards skin wounds inflicted by branding as the likely culprit for bacterial peritonitis and decompensated cirrhosis.