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Dematiaceous fungal keratitis following penetrating keratoplasty
Abstract:
A keratitis with an unusual, sessile, filamentary mass extending into the anterior chamber developed in a patient three weeks after penetrating keratoplasty. The causative organism was identified as Exophilia (Wangiella) dermatitidis, a dematiaceous fungus. The infection was cured with a combination of medical and surgical therapy. Inoculation of the isolate into rabbit corneas produced a similar keratitis from which the same organism was cultured. Miconazole levels measured in corneal tissue removed at surgery were approximately 25 times greater than the minimum inhibitory concentration for the fungal isolate.
Insights
A rare fungal keratitis caused by Exophilia dermatitidis occurred post-keratoplasty. Successful treatment involved antifungals and surgery, with high drug concentrations in corneal tissue.
Area of Science:
- Ophthalmology
- Mycology
- Infectious Diseases
Background:
- Post-keratoplasty infections can lead to sight-threatening complications.
- Fungal keratitis is a recognized but less common cause of corneal infection after surgery.
Observation:
- An unusual, sessile, filamentary mass extending into the anterior chamber was observed three weeks after penetrating keratoplasty.
- The causative agent was identified as Exophilia (Wangiella) dermatitidis, a dematiaceous fungus.
Findings:
- The fungal keratitis was successfully treated with a combination of medical (miconazole) and surgical therapy.
- Experimental inoculation in rabbit corneas replicated the keratitis, confirming Exophilia (Wangiella) dermatitidis as the pathogen.
- Corneal tissue miconazole levels were significantly higher (approx. 25x) than the minimum inhibitory concentration (MIC) for the isolate.
Implications:
- This case highlights Exophilia (Wangiella) dermatitidis as a potential pathogen in post-keratoplasty fungal keratitis.
- Effective management requires a combination of aggressive medical and surgical interventions.
- Achieving supra-therapeutic drug levels in corneal tissue may be crucial for successful treatment of resistant fungal infections.