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Rhodotorula rubra keratitis and melting after repeated penetrating keratoplasty
1Department of Ophthalmology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva- Israel.
Purpose:
To describe a rare case of Rhodotorula rubra keratitis in a corneal graft, and to discuss the management of this unusual pathogen.
Methods:
A 78-year-old debilitated man was treated for corneal abscess and descemetocele in his right eye. Urgent penetrating keratoplasty (PKP) with old donor material was performed. The patient underwent a new PKP when appropriate donor cornea was available. The graft was clear after the operation. Corneal cultures were negative.
Results:
One month after the second PKP procedure, deep stromal infiltrate with hypopyon appeared. Cultures grew R. rubra. A third PKP operation was performed. Systemic and topical amphotericin B treatment was started. Six months after the last operation the graft remains clear.
Conclusions:
Rhodotorula keratitis is an extremely rare infection that should be considered in debilitated patients with persistent and progressive corneal infection despite adequate antibiotic therapy.
Insights
This case study details Rhodotorula rubra keratitis in a corneal graft, a rare fungal infection. Prompt diagnosis and treatment with amphotericin B were crucial for graft survival.
Area of Science:
- Ophthalmology
- Mycology
- Infectious Diseases
Background:
- Corneal infections can be challenging, especially in immunocompromised individuals.
- Rhodotorula species are typically environmental yeasts, rarely causing invasive disease.
Observation:
- A 78-year-old debilitated patient developed Rhodotorula rubra keratitis in a corneal graft after two penetrating keratoplasties (PKP).
- Initial presentation involved deep stromal infiltrate and hypopyon despite negative cultures post-second PKP.
Findings:
- Cultures ultimately identified Rhodotorula rubra as the causative agent.
- Successful treatment involved a third PKP and systemic/topical amphotericin B therapy.
Implications:
- Rhodotorula keratitis is a rare but serious complication that warrants consideration in persistent corneal infections.
- Aggressive management, including antifungal therapy and potentially further surgical intervention, is key for favorable outcomes.
