A 55-year-old man presented to the emergency room with chief complaints of decreased vision, severe pain, tearing, and photophobia of his left eye after administering a drop of Kermes topical eye drops, which he obtained from a homeopathic/folk medicine man. Apart from hypertension, the patient’s medical history was unremarkable.\nOphthalmic examination revealed best corrected visual acuity of 20/30 in the right eye (OD) and 20/200 in the left eye (OS). Examination of the OD was unremarkable except for mild cataract. Examination of OS revealed swelling and black pigmentation over the upper eyelid. There was conjunctival chemosis along with well-demarcated black elevated areas inferonasally. Evidence of early cicatrization involving the fornix of the conjunctiva and symblepharon formation were present. Some particulate material from the lower fornix was removed and submitted for chemical analysis. Administration of topical fluorescein hydrochloride revealed a large epithelial defect involving the whole cornea []. There was no evidence of perilimbal ischemia. Intraocular pressure was normal in both eyes.\nThe left eye was immediately irrigated with normal saline for 30 min. The patient was instructed to frequently lubricate the left eye with preservative-free artificial tears in addition to the administration of topical Ofloxacin 0.3% drops 4 times a day for 1 week and topical prednisolone acetate 1% 4 times a day for the first week then it was tapered. In addition, topical cyclopentolate 1% drops 2 times a day were prescribed for the first 2 weeks. Over the following several days, the patient’s best corrected visual acuity improved to 20/60. Eyelid swelling along with skin discoloration completely resolved. The corneal epithelial defect healed completely without scarring \n[].\nGas chromatography/mass spectrometry of the submitted sample revealed the main ingredient to be kermesic acid (C18H12O9) consistent with Kermes. In addition to kermesic acid, there were elements of barium, iron, manganese, potassium, and copper. Six months after presentation, symblepharon was still noted, however, the best corrected visual acuity OS was 20/25 without corneal scar.
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.