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First Author: A.Mohd. Zahidin MALAYSIA
Co Author(s): S. Looi U. Md. Noh K. Then
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To report a case of non-resolving Fusarium keratitis which responded to intravenous voriconazole and oral itraconazole.
Universiti Kebangsaan Malaysia Medical Center
A 69-year-old Malay man presented with history of spontaneous left eye redness of one week duration associated with pain. The symptoms were progressive with deterioration of vision, photophobia, tearing and intolerable pain. Examination showed left eye central cornea abscess with hypoyon involving 1/3 of the anterior chamber. Visual acuity at presentation was hand movement. He was clinically treated as fungal keratitis with guttae Amphotericin B, guttae Voriconazole 1%, oral Fluconazole and subsequent addition of guttae Natamycin. However, his ocular condition deteriorated with enlargement of central cornea abscess and increasing hypopyon level. Therapeutic penetrating keratoplasty and intracameral washout with Voriconazole 1% was performed on day 25 of presentation. One week post-operatively, increasing inoculum superiorly and hypopyon level up to 1/2 anterior chamber was noted. Fusarium species was cultured from the cornea tissue and anterior chamber tap. Intravenous Voriconazole 200mg was given every 3 days with substitution of oral Fluconazole to Itraconazole. His condition improved dramatically within 3 days, with resolution of inoculum and hypopyon leaving only a streak line after 8 days of treatment.
Management of Fusarium sp.- related corneal ulcer is challenging, despite after therapeutic penetrating keratoplasty. Recent antimicrobial therapy guideline from Sanford have suggested that Fluconazole showed no clinical activity against Fusarium spp., hence may not be useful in Fusarium-related infection. Oral itraconazole and systemic voriconazole proved to be useful in eradicating the infective organism in this particular case.