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A 24-year-old contact lens wearer with unilateral vision loss requiring penetrating keratoplasty
Digital Journal of Ophthalmology 2019
Volume 25, Number 2
June 30, 2019
DOI: 10.5693/djo.03.2019.06.001
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Jonathan T. L. Lee, MBBS, BMedSc | Department of Ophthalmology, Alfred Health, Melbourne, Victoria, Australia Chengde Pham, MBBS, BMedSci | Department of Ophthalmology, Alfred Health, Melbourne, Victoria, Australia Edward Greenrod, MBBS, FRANZCO | Department of Ophthalmology, Alfred Health, Melbourne, Victoria, Australia
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| Differential Diagnosis | | The differential diagnosis for infectious keratitis is broad, particularly for contact lens wearers who are at an increased risk for bacterial and fungal ulcers. Prompt diagnosis with Gram stain and cultures of corneal samples are essential to determine treatment direction. In many cases, it may be difficult to differentiate early keratomycoses clinically from corneal ulcers caused by bacteria, viruses or Acanthamoeba, and broad-spectrum treatment is often initiated prior to microbe identification. In the present case, the indolent course, lack of response to topical ciprofloxacin, dense gray-white stromal infiltrate, and immune ring were suggestive of a filamentous fungal pathogen. Principal causes of filamentous keratitis include species of Fusarium, Aspergillus, Scedosporium apiospermum, and Paecilomyces, although many other species have been implicated.(1) Metarhizium anisopliae is a ubiquitous and parasitic, soilborne, filamentous fungus with a worldwide distribution; it has only rarely been reported as a human pathogen. | |
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