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Scedosporium-induced keratitis: insights from a case study
Liya Fathima1, L Annapurneswari1, Pooja Rao2
1Department of Microbiology, Kasturba Medical College Mangalore, Manipal Academy of Higher Education, Manipal, India.
Introduction:
Pseudallescheria boydii with its asexual form, Scedosporium apiospermum, is now recognized as an important emerging opportunistic pheoid-hypomycosis. Usually results in invasive infections in immunocompromised patients but rarely can infect the eyes. Herein, we report a challenging case of Pseudallescheria boydii keratitis in a lady with traumatic injury.
Case Report:
A 38-year-old female presented with alleged history of penetrating injury to right eye with stick by her spouse for which she was started on antibiotic eye drops from nearby local hospital and became symptomatically better. Later she had alleged history of ashes thrown to her right eye 2 weeks ago. She was referred here from a nearby hospital, with complaints of pain, itching, watering of eye and blurring of vision. On examination, Limbal -limbal ulcer with peripherally thinned out cornea and mucoid discharge was present. Corneal scrapings revealed P boydii. She was managed with antibiotics such as moxifloxacin, tobramycin and antifungals such as Natamycin, fluconazole. She did not improve symptomatically. She was referred to a higher center for keratoplasty and the patient was thus discharged for the same.
Conclusion:
Pseudallescheria boydii is a soil saprophytic, uncommon fungi entering body via respiratory or penetrating injury. It is often mistaken as Aspergillosis, This fungi shows resistance to amphotericin B, flucytosine and susceptible to triazoles. Surgical resection of lesion shows better outcome. The response of disseminated infection to combination therapy with interferon gamma and antifungal agents is encouraging.
Insights
A rare fungal eye infection caused by Pseudallescheria boydii (Scedosporium apiospermum) occurred after a traumatic eye injury. This case highlights the challenges in diagnosing and treating this emerging opportunistic infection.
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.
