Related Experiment Videos
Corneal chromoblastomycosis
K Barton1, D Miller, S C Pflugfelder
1Corneal and External Disease Service, Bascom Palmer Eye Institute, University of Miami School of Medicine, Florida, USA.
Purpose:
We sought to illustrate the difficulty in managing uncommon, pigmented mold-related corneal ulceration and to highlight the role of itraconazole in treating these patients.
Method:
We describe the management and clinical course of a patient with a recurring corneal infection caused by Fonsecaea pedrosoi and discuss this experience in the light of existing literature on management of cutaneous chromoblastomycosis.
Results:
A corneal ulcer caused by this organism healed initially on treatment with topical and systemic antifungal medication, but infection recurred in the deep stroma 4 months after cessation of therapy. After failure to respond to a further period of medical therapy, a small therapeutic penetrating keratoplasty was performed. Culture of a fibrinous membrane from the anterior iris surface demonstrated intraocular fungal infection, and postoperatively, an episode of marked fibrinous uveitis developed, suggesting the presence of viable intraocular fungal elements. A large penetrating keratoplasty was therefore performed with excision of involved iris in combination with extracapsular cataract extraction. F. pedrosoi was again cultured from the fibrinous membrane adherent to the iris and from the anterior lens capsule. Postoperatively the patient received a 5-month course of systemic itraconazole, and no further recurrences have been encountered after a further 2 months.
Conclusion:
F. pedrosoi is the organism most commonly isolated from the chronic cutaneous mycosis, chromoblastomycosis, and is relatively resistant to medical therapy. As has been reported for cutaneous disease, surgery in combination with systemic itraconazole may provide the best chance of cure in corneal chromoblastomycosis.
Insights
Managing rare, pigmented mold corneal ulcers is challenging. Systemic itraconazole combined with surgery offers the best treatment outcome for corneal chromoblastomycosis caused by Fonsecaea pedrosoi.
Area of Science:
- Ophthalmology
- Mycology
Background:
- Corneal ulceration caused by pigmented molds, such as Fonsecaea pedrosoi, presents a diagnostic and therapeutic challenge.
- Fonsecaea pedrosoi is the most common cause of cutaneous chromoblastomycosis, a chronic fungal infection.
Observation:
- A patient with recurrent corneal infection due to Fonsecaea pedrosoi initially responded to antifungal treatment but relapsed.
- Intraocular fungal infection was confirmed through cultures from fibrinous membranes during multiple surgical interventions.
Findings:
- Despite initial medical therapy and therapeutic penetrating keratoplasty, the corneal infection recurred.
- Aggressive surgical management including large penetrating keratoplasty and cataract extraction, followed by a 5-month course of systemic itraconazole, led to disease resolution.
Implications:
- Corneal chromoblastomycosis caused by Fonsecaea pedrosoi is often resistant to standard medical therapy.
- A combination of surgical intervention and systemic itraconazole appears to be the most effective treatment strategy for this challenging condition.