Resistant Fusarium keratitis progressing to endophthalmitis.

Area of Science:

• Ophthalmology
• Mycology
• Infectious Diseases

Background:

• Fungal keratitis is a significant cause of visual impairment.
• Fusarium species are common causes of fungal keratitis, but multidrug resistance is rare.

Observation:

• A soft contact lens wearer developed severe Fusarium keratitis after corneal abrasion.
• The infection progressed despite multiple aggressive antifungal treatments and surgical interventions, including penetrating keratoplasty and pars plana vitrectomies.

Findings:

• The causative agent was identified as a multidrug-resistant Fusarium solani species complex.
• The isolate showed partial sensitivity only to natamycin, rendering most standard antifungal therapies ineffective.
• The patient ultimately required enucleation due to the intractable infection and progression to endophthalmitis.

Implications:

• This case underscores the potential for devastating outcomes from multidrug-resistant fungal keratitis.
• The findings suggest a need for earlier and more frequent antifungal susceptibility testing, especially in cases unresponsive to empirical therapy.
• Increased vigilance for emerging antifungal resistance in Fusarium species is warranted.