J Korean Ophthalmol Soc.  2013 Apr;54(4):675-679. 10.3341/jkos.2013.54.4.675.

A Case of Fungal Keratitis Scedosporium apiospermum

• Lee S
• Lee DW
• Lee HS
• You IC

• KMID: 2216954
• DOI: http://doi.org/10.3341/jkos.2013.54.4.675

Abstract

PURPOSE
To report a case of fungal keratitis caused by Scedosporium apiospermum.
CASE SUMMARY
A 70-year-old man visited our clinic with complaints of redness and decreased visual acuity in his right eye caused by a soil gotten into an eye while gardening 10 days ago. The patient had previously been treated in a local clinic but did not show significant clinical improvement. Bacterial and fungal staining, culture, and an antibiotic sensitivity test were performed from a corneal scrape. The cultures revealed growth of Scedosporium apiospermum. The patient was treated with topical moxifloxacin antibiotics, fluconazole, amphotericin B antifungal agents. However, the lesion was not improved, so antifungal therapy was switched to topical voriconazole. After two months of treatment, the infection was resolved with mild scarring.
CONCLUSIONS
Although it is a rare pathogen, Scedosporium apiospermum should be considered as a potential pathogen in patients presenting with corneal ulceration due to trauma from an object contaminated by soil, polluted water, or spoiled plant contact. And we suggest that topical application of voriconazole may be a good alternative treatment for patient with fungal keratitis in which no improvement despite a conventional antifungal agent, fluconazole.

Keyword

Corneal ulcer; Fungal keratitis; Scedosporium apiospermum; Voriconazole

MeSH Terms

Amphotericin B
Anti-Bacterial Agents
Antifungal Agents
Aza Compounds
Corneal Ulcer
Eye
Fluconazole
Gardening
Humans
Keratitis
Plants
Pyrimidines
Quinolines
Scedosporium
Soil
Triazoles
Visual Acuity
Amphotericin B
Anti-Bacterial Agents
Antifungal Agents
Aza Compounds
Fluconazole
Pyrimidines
Quinolines
Soil
Triazoles

Figure

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  Figure 1. Corneal ulcer with deep stromal infiltration and surrounding edema were observed on initial presentation.

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  Figure 2. Dark gray­colored cottony colony on Sabouraud dextrose agar after incubation.

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  Figure 3. Microscopic morphology of Scedosporium apiospermum showing septate hyphae with simple long and short conidiophores (lactophenol cotton blue, ×;400).

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  Figure 4. After 2 months, the corneal lesion regressed completely.

Reference

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