Scedosporium-induced keratitis: insights from a case study.

Area of Science:

• Ophthalmology
• Mycology
• Infectious Diseases

Background:

• Pseudallescheria boydii (Scedosporium apiospermum) is an emerging opportunistic fungal pathogen.
• While typically causing invasive infections in immunocompromised individuals, it can rarely affect the eye.

Purpose of the Study:

• To report a challenging case of Pseudallescheria boydii keratitis.
• To discuss the diagnostic and management difficulties associated with this rare fungal infection following traumatic ocular injury.

Main Methods:

• A case report of a 38-year-old female with a history of penetrating eye injury.
• Clinical examination revealed a limbal ulcer with a thinned cornea and mucoid discharge.
• Corneal scrapings confirmed the presence of P boydii; treatment included broad-spectrum antibiotics and antifungals.

Main Results:

• The patient presented with pain, itching, watering, and blurred vision following trauma.
• Initial treatment with antibiotics and antifungals (moxifloxacin, tobramycin, natamycin, fluconazole) provided no symptomatic improvement.
• The patient was referred for keratoplasty due to the lack of response to medical management.

Conclusions:

• Pseudallescheria boydii, a soil saprophyte, can enter the body through penetrating injuries.
• This fungus is often misdiagnosed as Aspergillosis and exhibits resistance to amphotericin B and flucytosine, but susceptibility to triazoles.
• Surgical intervention and combination therapy may offer better outcomes for invasive infections.