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Posttraumatic phycomycosis of the anterior segment
Abstract:
Keratomycosis and infection of the anterior chamber with a Rhizopus sp (phycomycosis, mucormycosis) developed in a 24-year-old man following a perforating injury of the cornea with a soil-contaminated screwdriver. The infection was documented by positive cultures of the corneal wound and of the anterior chamber and by histopathologic studies. Phycomycosis of the eye usually occurs in the setting of systemically impaired host resistance. The patient had no underlying disease that wound predispose him to this infection but the treatment with topical 0.1% dexamethasone and triamcinolone acetonide suspension injected into the sub-Tenon's space following the injury may have impaired his local immunologic defenses. Excisional keratoplasty played an important role in the successful management of this case.
Insights
A corneal injury led to a rare fungal eye infection (keratomycosis) caused by Rhizopus. Prompt surgical intervention and antifungal treatment were crucial for managing this case of phycomycosis.
Area of Science:
- Ophthalmology
- Mycology
- Infectious Diseases
Background:
- Keratomycosis, a fungal infection of the cornea, is uncommon, particularly in immunocompetent individuals.
- Phycomycosis (mucormycosis) of the eye typically affects patients with compromised systemic immunity.
Observation:
- A 24-year-old male developed keratomycosis and anterior chamber infection with Rhizopus sp. after a corneal perforation from a soil-contaminated screwdriver.
- Cultures and histopathology confirmed the fungal infection in the corneal wound and anterior chamber.
- The patient had no predisposing systemic conditions, but recent topical and sub-Tenon's corticosteroid use may have impaired local ocular immunity.
Findings:
- Excisional keratoplasty was a key component in the successful treatment of this severe ocular fungal infection.
- The case highlights the potential for opportunistic fungal infections following ocular trauma, even without systemic immunosuppression.
Implications:
- This case underscores the importance of considering fungal etiologies in severe post-traumatic endophthalmitis.
- Aggressive surgical management combined with appropriate antifungal therapy is essential for limb and vision salvage in such cases.
- The role of localized corticosteroid use in potentiating opportunistic infections warrants further investigation.