Infectious crystalline keratopathy caused by Candida guilliermondii

Area of Science:

• Ophthalmology
• Mycology
• Infectious Diseases

Background:

• Infectious crystalline keratopathy (ICK) is a rare corneal infection.
• Fungal keratitis is a significant cause of ocular morbidity, especially in tropical regions.
• Candida species are increasingly recognized as opportunistic pathogens in ocular infections.

Observation:

• A case of ICK in a corneal transplant recipient with pseudophakic bullous keratopathy is reported.
• The causative organism was identified as Candida guilliermondii through lamellar biopsy.
• Histopathology revealed yeast aggregates within the corneal stroma without significant inflammation.

Findings:

• The ICK caused by Candida guilliermondii was indolent and resistant to prolonged topical and oral antifungal therapy (amphotericin B and fluconazole).
• Despite aggressive medical management, the infection persisted, indicating potential therapeutic challenges.
• Successful resolution was achieved only after a repeat penetrating keratoplasty.

Implications:

• This case highlights Candida guilliermondii as a rare but significant cause of ICK.
• Fungal keratitis, particularly by less common Candida species, should be considered in the differential diagnosis of recalcitrant ICK.
• The resistance of this isolate to standard antifungal treatments underscores the need for vigilance and potentially alternative therapeutic strategies in managing fungal keratitis.