Fungal keratitis caused by rare organisms

Abstract

Purpose: To report two rare cases of filamentous fungal keratitis.

Methods: Two non-consecutive patients presented with suspicious fungal keratitis. After performing the smear and culture, medical therapy was started for them. They underwent slit photography and in vivo confocal microscopy (IVCM) in their follow-up visits.

Results: The patients were 33-year-old and 56-year-old farmer men. They both mentioned a history of ocular trauma by plants. During their follow-up visits, corneal infiltration density and fungal hyphae density decreased in slit-lamp biomicroscopy and IVCM, respectively. The corresponding organisms were Pseudallescheria boydii (P. boydii) and Colletotrichum coccodes.

Conclusions: It is important to be aware of these rare organisms and their antibiotic susceptibility. There was not any specific confocal feature for the presented fungal keratitis that was different from other filamentous fungal hyphae; however, confocal scan is a good choice to follow the response to the treatment.

Keywords: Colletotrichum coccodes; Fungal keratitis; Pseudallescheria boydii.

Fig. 1

Clinical picture of the case 1. A, B: clinical picture of the patient at presentation. C, D: the patient developed hypopyon 20 days after initiating medication, but the density of infiltration was reducing. E, F: the infiltration is almost cleared with a central thinning.

Fig. 2

In vivo confocal microscopy (IVCM) of the patient. A: diffuse, hyper-reflective, branching and interlocking structures typical of fungal hyphae. B, C: The density of hyphae decreased after 5 days. D: The cornea is infiltrated by inflammatory cells. This image is synchronous with development of hypopyon. E, F: presence of inflammatory cells in the cornea (arrow).

Fig. 3

Clinical picture of the case 2. A: Slit photograph of the patient at presentation. B, C: reduced infiltration after 1 week and 3 weeks, respectively. D: slit photograph 2 months after presentation. Infiltration has turned into scar tissue with central thinning.

Fig. 4

In vivo confocal microscopy (IVCM) of the patient. A, B: hyper-reflective, branching, and interlocking structures typical of fungal hyphae. C, D: The reduction of fungal hyphae density can be seen in IVCM after 8 days. E, F: The IVCM is free of hyphae 2 weeks after starting the medication.