[Fungal keratitis caused by Scedosporium apiospermum].

Abstract

INTRODUCTION:

We report a case of posttraumatic keratomycosis caused by Scedosporium apiospermum that was treated with oral and topical voriconazole and penetrating keratoplasty.

CASE REPORT:

A patient was admitted to the hospital with a corneal abscess of his right eye due to trauma while gardening. No improvement was noted with topical fortified antibiotics (vancomycin, gentamicin, and cefazolin) and antimycotic (amphotericin B 1%) and oral itraconazole (200 mg/day). Fungal cultures of corneal scrapings revealed growth of Scedosporium apiospermum, a strain for which the main antifungals showed high minimal inhibitory concentrations (MICs), whereas the MIC of voriconazole was 0.125 microg/mL. Despite some improvement with topical 1% voriconazole and oral voriconazole (200 mg/day) treatment, a therapeutic penetrating keratoplasty was performed because of the high risk of corneal perforation. The graft remained clear without fungal recurrence with topical 2% cyclosporine A, dexamethasone, and voriconazole treatment.

CONCLUSION:

Scedosporium apiospermum is an uncommon cause of mycotic keratitis in humans. Prognosis is generally poor because of delayed diagnosis and resistance to conventional antifungals. Voriconazole is a triazole broad-spectrum antifungal agent. In conjunction with its oral administration, topical application of voriconazole extends the current armamentarium of antifungal agents for keratomycosis.

• Authors: C Ponchel, S Cassaing, M-D Linas, J-L Arné, P Fournié
• Journal: Journal francais d'ophtalmologie (J Fr Ophtalmol) Vol. 30 Issue 9 Pg. 933-7 (Nov 2007) ISSN: 1773-0597 [Electronic] France
• Vernacular Title: Kératite fongique à Scedosporium apiospermum.
• PMID: 18046279 (Publication Type: Case Reports, Journal Article)

Topics

• Aged
• Corneal Ulcer (drug therapy, microbiology)
• Eye Infections, Fungal (drug therapy, microbiology)
• Humans
• Keratitis (drug therapy, microbiology)
• Male
• Scedosporium (isolation & purification)