Severe Arthrographis kalrae keratomycosis in an immunocompetent Patient
Purpose: - To describe a severe case of keratomycosis caused by Arthrographis kalrae requiring repeated keratoplasty. - Methods: - A 42-year-old otherwise healthy soft contact lens wearer developed a unilateral central corneal ulcer. Treatment with topical and systemic vori...
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| Main Authors: | , , , , |
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| Format: | Article (Journal) |
| Language: | English |
| Published: |
2011
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| In: |
Cornea
Year: 2011, Volume: 30, Issue: 3, Pages: 364-366 |
| ISSN: | 1536-4798 |
| DOI: | 10.1097/ICO.0b013e3181eadeb9 |
| Online Access: | Verlag, lizenzpflichtig, Volltext: https://doi.org/10.1097/ICO.0b013e3181eadeb9 Verlag, lizenzpflichtig, Volltext: https://journals.lww.com/corneajrnl/Fulltext/2011/03000/Severe_Arthrographis_kalrae_Keratomycosis_in_an.23.aspx 
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| Author Notes: | Bettina C. Thomas, MD, Stefan Zimmermann, MD, Hans-Eberhard Völcker, MD, Gerd U. Auffarth, MD, and Stefan Dithmar, MD |
| Summary: | Purpose: - To describe a severe case of keratomycosis caused by Arthrographis kalrae requiring repeated keratoplasty. - Methods: - A 42-year-old otherwise healthy soft contact lens wearer developed a unilateral central corneal ulcer. Treatment with topical and systemic voriconazole is described. - Results: - Repeated microbiological testing of ocular swabs (culture) initially yielded Candida albicans. Under treatment with topical clotrimazole, the ulcer progressed, and a corneal perforation required a keratoplasty à chaud. For prophylaxis, the patient received fluconazole systemically and continuous topical clotrimazole. However, in 2 weeks time, the mycotic infiltrates penetrated the corneal transplant and led to a second keratoplasty only 1 month after the first one. In the meantime, the microbiological analysis of the first keratoplasty revealed A. kalrae, which was sensitive to voriconazole. High-dose serum level-controlled systemic voriconazole and topical voriconazole were able to stabilize, but not eliminate the infection. About 1 year after the start of the voriconazole therapy, treatment had to be discontinued because of side effects. Mycotic infiltrates increased, and even an intracameral voriconazole injection could not prevent a third and a fourth keratoplasty. - Conclusions: - Ocular infection with A. kalrae is very rare. The microbiological differentiation of A. kalrae can be difficult. Because a broad spectrum of fungi is sensitive to voriconazole, the early topical and possibly systemic treatment is a reasonable therapeutic option when a mycotic infection of the eye is suspected, even before the causative fungus is identified. |
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| Item Description: | Gesehen am 02.11.2022 |
| Physical Description: | Online Resource |
| ISSN: | 1536-4798 |
| DOI: | 10.1097/ICO.0b013e3181eadeb9 |