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Case Reports
. 2017 Jul 11;6(1):612.
doi: 10.4102/ajlm.v6i1.612. eCollection 2017.

Cylindrocarpon lichenicola keratomycosis in Nigeria: the challenge of limited access to effective antimicrobials

Emmanuel O Irek  1 , Temitope O Obadare  1 , Patrick A Udonwa  2 , Olajumoke Laoye  2 , Oyekola V Abiri  1 , Adenike O Adeoye  2 , Aaron O Aboderin  1
Affiliations
Case Reports

Cylindrocarpon lichenicola keratomycosis in Nigeria: the challenge of limited access to effective antimicrobials

Emmanuel O Irek et al. Afr J Lab Med. .

Abstract

Introduction: We report a rare cause of keratitis, due to Cylindrocarpon lichenicola, in a farmer with keratomycosis. Despite the acknowledged virulence of this fungus, a suitable antifungal for its management was not accessible.

Case presentation: A 67-year-old farmer presented with a two-week history of pain, mucopurulent discharge, redness and a corneal ulcer with a visual acuity of hand movement in the right eye. With a working diagnosis of infective keratitis, corneal scrapings were taken under a slit lamp biomicroscope for microbiological testing. Direct lactophenol cotton blue mounts revealed septate fungal hyphae, while fungal culture on Sabouraud dextrose agar at room temperature grew woolly mould phenotypically consistent with C. lichenicola.

Management and outcome: The patient was started on hourly topical natamycin (5%), ciprofloxacin (0.3%), two-hourly instillation of tobramycin (0.3%) and atropine (1%) twice daily for three months following the isolation of the fungus. The eye healed with a corneal scar and no improvements in visual acuity.

Discussion: This infection was difficult to manage due to the inaccessibility of a suitable antifungal, namely, voriconazole in our setting. Hence, there is a need for prompt identification and early institution of suitable antifungals in any patient with suspected keratomycosis.

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Conflict of interest statement

The authors declare that they have no financial or personal relationships which may have inappropriately influenced them in writing this article.

Figures

FIGURE 1
FIGURE 1
Right eye examination showing hypopyon, corneal ulcer measuring 5.5 x 4 mm with irregular margins.
FIGURE 2
FIGURE 2
Right eye examination under slit lamp with fluorescein dye highlighting the corneal ulcer.
FIGURE 3
FIGURE 3
Woolly mould with reddish brown pigmentation after culture of corneal scraping on Sabouraud dextrose agar at room temperature for 48 hours.
FIGURE 4
FIGURE 4
Cylindrocarpon lichenicola chlamydospores, conidiophores and conidia stained with lactophenol phenol cotton blue (x400 magnification).
See this image and copyright information in PMC

References

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