Candida albicans keratitis modified by steroid application

Area of Science:

• Ophthalmology
• Mycology
• Infectious Diseases

Background:

• Postoperative ocular infections pose significant challenges in diagnosis and management.
• Steroid administration is common in managing ocular inflammation but can mask or exacerbate infections.

Observation:

• A patient presented with symptoms initially suggestive of inflammation post-eye surgery, treated with antibiotics and steroids.
• Initial presentation showed a corneal endothelial plaque without epithelial erosion, misleading towards non-infectious etiology.
• Discontinuation of steroid eye drops rapidly revealed classic signs of infectious keratitis, including epithelial defects and stromal infiltration.

Findings:

• Smear and culture from the corneal plaque confirmed Candida albicans infection.
• The patient's condition improved with topical and oral antifungal medications, including fluconazole, micafungin, pimaricin, and itraconazole.
• Early diagnostic signs of fungal keratitis were masked by prior steroid treatment.

Implications:

• Ophthalmologists must exercise caution when prescribing steroid eye drops, especially in postoperative patients with potential for infection.
• Recognizing drug-induced masking is critical for accurate diagnosis of infectious keratitis.
• This case highlights the importance of considering fungal infections in atypical or non-responsive postoperative ocular conditions.