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Pythium insidiosum keratitis in contact lens wear: a case report
Kaevalin Lekhanont1, Varintorn Chuckpaiwong, Piriyaporn Chongtrakool
1Department of Ophthalmology, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Insights
This case report details a Pythium insidiosum corneal ulcer in a contact lens wearer. Early diagnosis and intervention are crucial for managing this rare but severe infection.
Area of Science:
- Ophthalmology
- Infectious Diseases
- Medical Mycology
Background:
- Contact lens wear is a known risk factor for microbial keratitis.
- Pythium insidiosum, an oomycete, can cause severe, sight-threatening infections.
Observation:
- A 22-year-old woman presented with a nonresponsive corneal ulcer after contact lens wear.
- Clinical examination revealed a large central ulcer with stromal infiltrates and radial keratoneuritis.
- Histopathology and culture confirmed Pythium insidiosum keratitis.
Findings:
- The patient experienced recurrent infections despite multiple corneal transplants.
- Enucleation was ultimately required to control the infection.
- This is the first reported case of contact lens-related Pythium insidiosum keratitis.
Implications:
- Pythium keratitis can mimic Acanthamoeba keratitis, necessitating a high index of suspicion.
- Prompt diagnosis and aggressive treatment are vital for improving patient outcomes.
- Increased awareness among clinicians regarding contact lens-related Pythium infections is recommended.
Purpose:
The purpose of this study was to report a case of contact lens-related Pythium insidiosum corneal ulcer.
Methods:
The authors conducted an interventional case report. We report the clinical presentations, histopathologic findings, and treatments of a patient with P. insidiosum keratitis associated with contact lens wear.
Results:
A 22-year-old Thai woman presented to our clinic with a nonresponsive, progressive corneal ulcer of the left eye. Slit lamp examination showed a large central ulcer measuring 5.4 x 5.2 mm with underlying dense stromal infiltrates surrounded by subepithelial and superficial stromal opacity in a reticular pattern along with radial perineural-like infiltrates. Histopathologic examination revealed broad, branched, thin-walled nonparallel hyaline hyphae with rare septates consistent with P. insidiosum. The corneal culture confirmed the diagnosis. The infection recurred after multiple therapeutic penetrating keratoplasties. Enucleation was eventually performed to eradicate the infection. No definite report of contact lens-related P. insidiosum keratitis existed in the literature.
Conclusion:
Pythium keratitis may present with central ulcer and radial keratoneuritis similar to acanthamoeba keratitis. Contact lens wear can be a risk factor for this infection. Increasing awareness, early diagnosis, and intervention may improve the prognosis.
