Successful Treatment of Lasiodiplodia theobromae Keratitis - Assessing the Role of Voriconazole

Abstract

Purpose: The aim of this paper is to report the successful management of the first case of Lasiodiplodia theobromae keratitis in Hong Kong.

Methods: We conducted a case report.

Results: A 43-year-old Chinese male with a history of diabetes developed left eye keratitis after a trauma during tree felling. Fungal keratitis was diagnosed using a confocal microscope on day 1, and L. theobromae was confirmed from the culture. He was given oral voriconazole, topical natamycin, and topical and intracameral amphotericin B. The patient's condition improved after the initial treatment. However, there was a slow progression to descemetocele formation and impending perforation due to corneal melting. Penetrating keratoplasty was performed at 8 weeks after presentation. Final visual recovery was good with no recurrence of infection. The cornea remained clear.

Conclusions: We report the first case of L. theobromae keratitis in Hong Kong, and it is the only case so far that involved the use of oral voriconazole in the combination therapy. Early recognition with the aid of confocal microscopy allowed the early start of treatment. The use of newer antifungal voriconazole topically and orally combined with topical amphotericin B appeared to be useful in the eradication of the fungus and prevention of recurrence. Intracameral antifungals might have improved the clinical management.

Keywords: Fungus; Keratitis; Lasiodiplodia theobromae; Voriconazole.

Fig. 1

Corneal infiltrate of 3 mm in superficial to mid-stroma with visible fungal hyphae at the periphery on slit-lamp examination.

Fig. 2

Specular microscopy showing fungal hyphae in superficial to mid-stroma (64–117 µm in depth).

Fig. 3

Clear cornea maintained at 4 weeks after keratoplasty with no signs of recurrent infection.