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A case report of alternaria keratitis: laboratorial diagnosis and resolution with intracameral voriconazole injection

Poster Details

First Author: K.Kang SOUTH KOREA

Co Author(s):    H. Kim                    

Abstract Details

Purpose:

Alternaria species belong to a group of dematiaceous fungi and are ubiquitous in the environment as saprophytes of humans. Alternaria species have been reported to cause cutaneous and subcutaneous infections, onychomycosis, sinusitis, visceral infections, and osteomyelitis. However, corneal infection caused by Alternaria is less common and cases reporting infection in corneal tissue are rare. This present report describes a case of keratitis caused by A. alternata isolated from corneal tissue.

Setting:

Department of Ophthamology, Changwon Samsung Medical Center, Changwon, Korea, Republic of.

Methods:

A 71-year-old man presented with pain. Slit-lamp biomicroscopy revealed a 3×3 mm deep corneal stromal infiltrate, with a 2×2 mm epithelial defect. The patient was started on hourly doses of topical moxifloxacin, voriconazole 2%, and natamycin. This treatment, however, was not effective and the corneal infiltration worsened. Subsequently, the patient underwent therapeutic penetrating keratoplasty. On Potato Corn Meal Tween 80 agar, the mold from excised corneal tissue formed brown/gray colonies and slide cultures revealed many yellow/brown, septated, and club-shaped ascospores. The presence of A. alternata in the culture was confirmed by 18S rRNA sequencing.

Results:

Although the transplanted corneal graft was well attached with clearance, deep corneal infiltration remained on the host’s posterior corneal stroma. Intracameral voriconazole (100 µg/0.1 cc) and subconjunctival voriconazole (300 µg/0.3 cc) were injected. This procedure was performed every other day for 2 weeks. One month after the injection of antifungal agents was administrated, the periphery of the corneal graft showed decreased infiltration. All topical antifungal agents were tapered and discontinued 2 months after surgery. The cornea remained clear 5 months postoperatively; there was no recurrence of fungal infection and BCVA in the left eye was 20/100.

Conclusions:

Fungal keratitis is a potentially sight-threatening corneal infection due to the difficulties associated with its diagnosis and treatment. To our knowledge, this is the first case to report a successful outcome using intracameral voriconazole injection for Alternaria keratitis. In conclusion, deep corneal infection of A. alternata was confirmed by laboratorial diagnosis and effectively treated with intracameral voriconazole injection.

Financial Disclosure:

NONE

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