A Rare Case Of Exophiala Dermatitidis Graft Infection

Exophiala dermatitidis graft infection has not been resported previously in India, to the best of our knowledge.

We report Exophiala dermatitidis graft infection in a 49-year-old female patient post penetrating keratoplasty. Microscopically, the slide culture showed abundant single celled, oval, light brown yeast-like cells that were arranged in chains. Also, few septate hyphae with annelids bearing ellipsoidal conidia along with terminal and intercalary phialides were seen. 

A 49-year-old female, followup patient of right eye penetrating keratoplasty presented to the outpatient department with pain, redness and diminution of vision. On examination patient had frank perforation with flat anterior chamber. Vision was hand movements close to face (HMCF) with accurate projection of rays, and the ultrasound of the posterior segment was anechoic. There was distinct pigmentation of the graft. Patient was admitted for repeat graft with 8 mm non optical grade cornea secured with sixteen 10-0 monofilament nylon sutures. Antifungals were started. Infected graft was sent for microbiological analysis. The fungal culture grew black mucoid yeast-like colonies after seven days of incubation at 25°C.  A slide culture was put for further identification. Microscopically the slide culture showed abundant single celled, oval, light brown yeast-like cells that were arranged in chains. Also, few septate hyphae with annelids bearing ellipsoidal conidia along with terminal and intercalary phialides were seen. Based on the macroscopic and microscopic features, the fungal isolate was identified as Exophiala dermatitidis.  The antifungal susceptibility was performed by E-test. Subsequently the second graft again got infected and patient presented with inaccurate projection of rays in two quadrants . Patient refused further surgical intervention and was managed medically. Ultimately the infection was controlled with pseudocornea formation.

Exophiala is an opportunistic fungus and can result in severe, recalcitrant graft infection ultimately leading to loss of the eye despite aggressive treatment.