Tintelnotia destructans Keratitis: A Clinicopathological Report and Review of the Literature

Abstract

Purpose: To present the first clinicopathological report of Tintelnotia destructans keratitis, a filamentous fungus and as of yet uncommon virulent ocular pathogen.

Methods: A 70-year-old man presented with an infectious keratitis featuring a stromal infiltrate with feathery borders and a viscous hypopyon. Despite initial improvement under a combined therapy with natamycin and voriconazole, a perforation in the further course required a penetrating keratoplasty. Cultures and the corneal lenticule were available for microscopic examination and antifungal susceptibility testing. The limited literature on the subject was reviewed.

Results: Microscopic examination of cultures revealed hyphae and conidia being produced in globose fruiting bodies, a common characteristic of Tintelnotia sp. Histopathology showed short-branched hyphae that grew across the cornea regardless of the orientation of the collagen lamellae. Molecular methods identified the species T. destructans. The pattern of antifungal susceptibility included amphotericin B, ciclopirox, natamycin, posaconazole, voriconazole, and terbinafine. The postoperative clinical course was without complications.

Conclusions: Although the clinical signs corresponded to the classic features of fungal keratitis, microscopic analysis revealed morphological characteristics of a fungal class that has shown little ophthalmological appearance so far. Data on T. destructans keratitis are highly limited in the literature, but all identified species shared sensitivity to terbinafine.