Acremonium keratomycosis in a cat

Area of Science:

• Veterinary Ophthalmology
• Mycology
• Infectious Diseases

Background:

• Fungal keratitis is a challenging ocular disease in cats, often requiring prompt diagnosis and targeted therapy.
• Superficial corneal ulceration can progress to severe stromal loss if left untreated, leading to potential vision impairment.

Observation:

• A 14-year-old cat presented with progressive superficial corneal ulceration, mucoid discharge, and blepharospasm.
• Ocular examination revealed ulcerative keratitis with stromal loss, chemosis, corneal edema, miosis, aqueous flare, and hyphema.
• Corneal cytology identified branching, septate fungal hyphae, and fungal culture confirmed Acremonium species.

Findings:

• Initial treatment with topical 1% miconazole led to clinical deterioration.
• Switching to topical 1% voriconazole solution successfully resolved the Acremonium fungal keratitis.
• PCR testing of cytology samples was negative for fungal elements despite positive culture and cytology findings.

Implications:

• Topical voriconazole demonstrates clinical efficacy in treating feline fungal keratitis caused by Acremonium.
• Discrepancies between in vitro antifungal susceptibility and clinical outcomes warrant further investigation.
• This case underscores the importance of considering fungal etiologies in refractory ulcerative keratitis and adapting treatment based on clinical response.