First Report of Neocucurbitaria unguis- hominis Keratitis

Abstract

Coelomycetous fungi are among the emerging causes of infections and have been involved in many kinds of infections, including keratitis and endophtalmitis. Here, we present the first case of keratitis caused by Neocucurbitaria unguis-hominis, a coelomycetous fungus belonging to the family Cucurbitariaceae. In this case report, we describe the clinical presentation of a 56-year-old woman, a regular contact lens wearer, who was treated for pain in her right eye and fixed spot vision after an injury with plant debris. On examination, a corneal ulcer was observed, the foreign body was removed, and topical eye-drop therapy was started. After an initial improvement, the patient returned three weeks later due to a recurrence of discomfort in her right eye, observing the persistence of the corneal ulcer. Corneal scrapings were taken for culture, growing a filamentous fungus after seven days, which was identified by sequencing the fungal internal transcribed spacer region. It should be noted that microbiological identification of the coelomycetes in the clinical laboratory is not easy because of their difficulty in sporulating, making molecular techniques based on the amplification and sequencing of appropriate phylogenetic markers essential. Identification of these fungi is mandatory in order to optimise treatment due to the difficulty in eradicating them with antifungal treatment, requiring surgery in 50% of cases.

Keywords: Neocucurbitaria unguis-hominis; Phaeohyphomycosis; Pyrenochaeta; Pyrenochaeta unguis-hominis; coelomycetes; fungal keratitis.

Figure 1

Slit lamp examination showed a dry-looking ulcer with stellate feathery or irregular margins with associated satellite lesions (A). Pentacam Scheimpflug imaging was also obtained, showing inferior thinning of the ulcer (B) and some calcific precipitates with 50% infiltration of the corneal thickness (C). Colonies on Sabouraud-detroxe agar plates (surface) (D).