Fungal keratitis secondary to Scedosporium apiospermum infection and successful treatment with surgical and medical intervention

To report a rare case of severe fungal keratitis caused by Scedosporium apiospermum , which was treated with a penetrating tectonic keratoplasty and aggressive medical treatment. A 62-year-old woman with a history of soil contamination of the right eye while planting vegetables presented with a seve...

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Bibliographic Details
Published in:International ophthalmology 2014-04, Vol.34 (2), p.305-308
Main Authors: Kepez Yildiz, Burcin, Hasanreisoglu, Murat, Aktas, Zeynep, Aksu, Gulsah, Kocak, Burcak Comert, Akata, Fikret
Format: Article
Language:English
Subjects:
Antifungal Agents - therapeutic use
Case Report
Corneal Transplantation
Eye Infections, Fungal - microbiology
Female
Gardening
Humans
Keratitis - microbiology
Medicine
Medicine & Public Health
Middle Aged
Ophthalmology
Scedosporium - isolation & purification
Scedosporium apiospermum
Treatment Outcome
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Summary:To report a rare case of severe fungal keratitis caused by Scedosporium apiospermum , which was treated with a penetrating tectonic keratoplasty and aggressive medical treatment. A 62-year-old woman with a history of soil contamination of the right eye while planting vegetables presented with a severe corneal abscess and ocular pain. The patient received medical treatment and underwent tectonic keratoplasty. Both corneal scrapings and the corneal button were evaluated microscopically. The samples were sent for aerobic and anaerobic bacterial and fungal cultures. Microbiological examinations showed S. apiospermum . The isolate was sensitive to amphoterycine B, caspofungin, voriconazole, and resistant to fluconazole. No clinical improvement was achieved with topical voriconazole, vancomycin, ceftazidime, and systemic voriconazole. A penetrating tectonic keratoplasty and lensectomy with continuation of anti-fungal therapy achieved satisfactory results. A fungal etiology should be suspected in a progressive and untreatable corneal abscess. Microbiological investigation is very important in early diagnosis. Despite early diagnosis and aggressive treatment, in selected cases removing the infected tissue surgically is vital in preserving the ocular globe and vision.
ISSN:0165-5701
1573-2630
DOI:10.1007/s10792-013-9777-8