Giovannini Joseph, Lee Rick, Zhang Sean X, Jun Albert S, Bower Kraig S
Johns Hopkins University, Baltimore, Md., USA.
Case Rep Ophthalmol. 2014 Oct 2;5(3):302-10. doi: 10.1159/000365986. eCollection 2014 Sep.
To describe a case of fungal keratitis involving an atypical organism with confirmatory in vivo confocal microscopy and to review the literature on Rhodotorula keratitis.
Case report and review of the medical literature.
A 22-year-old college student was struck in the left eye with a tree branch and subsequently developed pain, redness and photophobia. Upon presentation, visual acuity was 20/200 and there was a large epithelial defect with diffuse stromal inflammation involving the anterior one-third of the cornea. Cultures of the infiltrate were performed for bacterial, viral and fungal organisms that resulted in a positive culture for Rhodotorula mucilaginosa. Fungal elements were confirmed in vivo by confocal microscopy. The patient was treated with voriconazole initially and had amphotericin added once Rhodotorula infection was confirmed. The patient responded well clinically, and one month after therapy was initiated, the corneal infiltrate had resolved leaving mild anterior stromal haze. Upon completion of therapy at three months, the patient was asymptomatic, had a clear cornea and had a best corrected visual acuity of 20/20 in the involved eye. There was no measurable change in his manifest refraction.
Prior cases of Rhodotorula keratitis most often required surgical intervention and were associated with poor outcomes. This case shows that Rhodotorula keratitis can be successfully treated with topical antifungal agents if diagnosed early and appropriate treatment is initiated promptly. We report the first case of Rhodotorula keratitis confirmed by in vivo confocal microscopy. This is also the first description of pseudomycelium formation that has not been previously described in vivo, a morphological structure that this organism rarely demonstrates. Finally, this case shows that confocal microscopy may aid in the early diagnosis and management of fungal keratitis involving this rare but potentially damaging organism.
描述一例经活体共聚焦显微镜确诊的由非典型病原体引起的真菌性角膜炎病例，并回顾关于红酵母属角膜炎的文献。
病例报告及医学文献回顾。
一名22岁的大学生左眼被树枝击中，随后出现疼痛、眼红和畏光症状。就诊时，视力为20/200，存在一个大的上皮缺损，伴有累及角膜前1/3的弥漫性基质炎症。对浸润灶进行了细菌、病毒和真菌培养，结果显示粘红酵母培养阳性。通过共聚焦显微镜在活体中确认了真菌成分。患者最初接受伏立康唑治疗，确诊红酵母感染后加用两性霉素。患者临床反应良好，治疗开始1个月后，角膜浸润消退，仅留下轻度前基质混浊。3个月治疗结束时，患者无症状，角膜透明，患眼最佳矫正视力为20/20。其明显屈光不正无明显变化。
既往红酵母属角膜炎病例大多需要手术干预，且预后较差。本病例表明，如果早期诊断并及时开始适当治疗，红酵母属角膜炎可用局部抗真菌药物成功治疗。我们报告了首例经活体共聚焦显微镜确诊的红酵母属角膜炎病例。这也是对假菌丝形成的首次描述，此前在活体中尚未有过描述，这种形态结构该病原体很少表现出来。最后，本病例表明共聚焦显微镜可能有助于早期诊断和管理由这种罕见但可能具有破坏性的病原体引起的真菌性角膜炎。
