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Phialophora chinensis fungal keratitis: An initial case report and species identification
Briana Ply1, Connie F Cañete-Gibas2, Carmita Sanders2
1Department of Ophthalmology, Eastern Virginia Medical School, Norfolk, VA, USA.
Purpose:
To report the initial case of microbial keratitis caused by Phialophora chinensis, a rare cause of fungal keratitis.
Observations:
A 66-year-old gentleman with a complex right eye (OD) ocular history including herpes simplex virus infectious epithelial keratitis with subsequent neurotrophic keratopathy, and prior combined Candida albicans and parapsilosis fungal keratitis presented with pain OD in the absence of an antecedent trauma. The patient was found to have a filamentous fungal keratitis, which was subsequently cultured and identified as Phialophora chinensis by the laboratory. Despite topical and oral antifungal treatment based on sensitivities determined by the lab, the patient ultimately required intrastromal and subconjunctival antifungal injections, corneal crosslinking, and superficial keratectomy with amniotic membrane to clinically improve. The fungal keratitis recurred twice, with each occurrence rapidly progressing to corneal perforation. Months after the second penetrating keratoplasty, the patient's mental status declined due to multiorgan failure. An occult pulmonary malignancy was discovered during this hospital stay, and the patient was lost to follow-up after entering hospice.
Conclusions And Importance:
We report a unique case of fungal keratitis caused by Phialophora chinensis and the subsequent management, including both medical and surgical interventions. Despite a multimodal treatment regimen, this case demonstrates the recalcitrant and potentially recurrent nature of fungal keratitis caused by P. chinensis.
Insights
This case report details the first instance of fungal keratitis caused by Phialophora chinensis. The rare infection proved recalcitrant, requiring extensive treatment and ultimately recurring, highlighting its aggressive nature.
Area of Science:
- Ophthalmology
- Mycology
- Infectious Diseases
Background:
- Fungal keratitis poses a significant threat to vision, especially in immunocompromised individuals or those with ocular surface disease.
- Phialophora species are infrequently implicated in human infections, with Phialophora chinensis rarely reported as a cause of keratitis.
Observation:
- A 66-year-old male with a history of herpetic epithelial keratitis and prior fungal keratitis presented with unilateral eye pain.
- Microbial keratitis was diagnosed and identified as Phialophora chinensis via laboratory culture.
- The patient underwent a complex treatment course including topical/oral antifungals, intrastromal/subconjunctival injections, corneal crosslinking, and amniotic membrane grafting.
Findings:
- Despite aggressive multimodal therapy, the patient experienced two recurrences of fungal keratitis, each leading to corneal perforation.
- The infection necessitated repeated penetrating keratoplasty.
- The patient's condition deteriorated, leading to multiorgan failure, discovery of pulmonary malignancy, and eventual hospice care.
Implications:
- This case highlights Phialophora chinensis as a rare but potentially aggressive and recurrent cause of fungal keratitis.
- Management requires a multimodal approach, often involving surgical interventions beyond standard antifungal therapy.
- The recalcitrant nature of P. chinensis keratitis underscores the need for vigilant monitoring and prompt intervention.
