He Hong, Liu Hongshan, Chen Xiaolian, Wu Jiaochan, He Miao, Zhong Xingwu
Hainan Eye Hospital and Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Haikou, Hainan, China (mainland).
Zhongshan Ophthalmic Center and State Key Laboratory of Ophthalmology, Sun Yat-sen Universityq, Guangzhou, Guangdong, China (mainland).
Am J Case Rep. 2016 Dec 27;17:982-988. doi: 10.12659/ajcr.901158.
BACKGROUND Pythium insidiosum keratitis is a rare but sight-threatening disease with a high morbidity rate. It can be misdiagnosed as fungal keratitis in clinic settings. We report a case of severe Pythium insidiosum keratitis in a Chinese child, treated with combined approaches. CASE REPORT A 7-year-old boy from Hainan province in the south of China developed a suppurative corneal ulcer after being in a forest. A mass of hyphae was detected by confocal imaging in vivo, fungal smear test, and histochemical examination. Treatment with Natamycin, fluconazole, and Voriconazole for 1 month was unsuccessful, and a penetrating keratoplasty with anterior vitrectomy was performed. The infection reappeared 1 day after surgery, immediately after which anterior chamber irrigation with 0.02% Fluconazole and amphotericin B solution was performed. Finally, the globe was saved and there was no further recurrent infection. A cultured mycelial organism, which was hard to identify by biomorphology, was confirmed by PCR to be Pythium insidiosum. The zoospores were observed in water environments. The imaging characteristics of P. insidiosum in confocal microscopy are described herein. CONCLUSIONS This is the first case of Pythium insidiosum keratitis reported in China. It can be misdiagnosed as fungal keratitis in the clinic. Improving the awareness of clinicians, promoting early diagnosis, and a multidisciplinary approach, especially early surgery, improve the prognosis.
棘壳孢菌性角膜炎是一种罕见但威胁视力的疾病，发病率高。在临床环境中它可能被误诊为真菌性角膜炎。我们报告一例中国儿童严重棘壳孢菌性角膜炎病例，采用联合方法进行治疗。病例报告：一名来自中国南方海南省的7岁男孩在进入森林后出现化脓性角膜溃疡。通过共聚焦成像活体检测、真菌涂片检查和组织化学检查发现大量菌丝。用那他霉素、氟康唑和伏立康唑治疗1个月未成功，遂行穿透性角膜移植联合前部玻璃体切除术。术后1天感染复发，随即用0.02%氟康唑和两性霉素B溶液进行前房冲洗。最终，眼球得以挽救，且未再复发感染。一种通过生物形态学难以鉴定的培养菌丝体生物，经聚合酶链反应确认为棘壳孢菌。在水环境中观察到游动孢子。本文描述了棘壳孢菌在共聚焦显微镜下的成像特征。结论：这是中国报道的首例棘壳孢菌性角膜炎病例。在临床上它可能被误诊为真菌性角膜炎。提高临床医生的认识、促进早期诊断以及采用多学科方法，尤其是早期手术，可改善预后。
