Candida Parapsilosis Fungal Keratitis: Two Case Reports

Candida Parapsilosis Fungal Keratitis: Two Case Reports Highlighting Clinical Presentation, Risk Factors, and Outcomes

Tertiarry Referral Centre - Birmingham and Midland Eye Centre

Fungal keratitis, though less common than bacterial infections, presents significant clinical challenges, particularly in immunocompromised patients and those with a history of ocular surgery. We report two distinct cases of Candida parapsilosis keratitis, emphasizing the differences in clinical presentation, risk factors, and outcomes.

Case 1: A 80-year-old immunosuppressed male with a history of persistent epithelial defects secondary to herpes simplex virus (HSV) and herpes zoster virus (HZV) keratitis presented with fuzzy, white deposits on the corneal stroma. His underlying immunosuppressive therapy increased his susceptibility to fungal infection, manifesting in this classic, diffuse fungal keratitis pattern.

Case 2: A 79-year-old female who underwent a stromal patch corneal transplant for corneal perforation and was on long-term topical steroids presented with a crystalline keratopathy-like appearance. She exhibited typical signs of fungal infection in a post-operative context with a history of steroid use, which is known to increase the risk of opportunistic infections such as fungal keratitis.

Both cases were successfully managed with a combination of oral voriconazole, topical voriconazole, and topical Amphotericin B. The outcomes were favorable, with resolution of infection in both cases, though the clinical presentations differed significantly.

These cases underscore the importance of recognizing Candida parapsilosis fungal keratitis in patients with specific risk factors such as immunosuppression and post-operative steroid use. Early diagnosis and appropriate antifungal therapy are crucial for improving clinical outcomes.