Ting Darren Shu Jeng, Bignardi Giuseppe, Koerner Roland, Irion Luciane D, Johnson Elizabeth, Morgan Stephen J, Ghosh Saurabh
Sunderland Eye Infirmary (D.S.J.T., S.J.M., and S.G.), Sunderland, United Kingdom; Department of Microbiology (G.B. and R.K.), Sunderland Royal Hospital, Sunderland, United Kingdom; Histopathology Department (L.D.I.), Central Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom; and Mycology Reference Laboratory (E.J.), Public Health England South West Laboratory, Bristol, United Kingdom.
Eye Contact Lens. 2019 Mar;45(2):e5-e10. doi: 10.1097/ICL.0000000000000517.
To report the first case of fungal keratitis caused by Cryptococcus curvatus after penetrating keratoplasty (PK) in an immunocompetent patient and to describe its therapeutic challenge and long-term outcome.
An interventional case report.
A 54-year-old female patient underwent right PK for lattice dystrophy. At 5-year post-PK, she developed a polymicrobial keratitis caused by Candida parapsilosis, and Stenotrophomonas maltophilia at the peripheral graft, which was successfully treated with topical antibiotic and antifungal drops. One year later, another fungal keratitis occurred which apparently resolved with antifungal treatment but recurred in an unusual fashion and required a repeat PK revealing the diagnosis of C. curvatus keratitis. This was confirmed by microbiological culture on Sabouraud dextrose agar, nuclear ribosomal repeat regional sequencing of the D1-D2 and internal transcribed spacer regions, and histopathological examination. Various topical, intracorneal, and systemic antifungal treatments had been attempted but failed to resolve the infection completely, necessitating a subsequent third PK. A further recurrence was noted 16-month post-third PK, which was eradicated with multiple topical and intracorneal antifungal treatment, and direct cryotherapy to the corneal abscess. No further recurrence of C. curvatus was noted at 4-year follow-up.
Cryptococcus curvatus should be added to the known list of organisms capable of causing fungal keratitis. Our experience suggests that this type of organism could cause low-grade, grumbling infection, which may however be exceptionally difficult to treat. Long-term eradication of this rare fungal keratitis could be potentially achieved by intensive ocular and systemic antifungal treatment, repeat therapeutic keratoplasties, and focal cryotherapy.
报告首例免疫功能正常患者穿透性角膜移植术（PK）后由弯隐球菌引起的真菌性角膜炎病例，并描述其治疗挑战及长期预后。
一项介入性病例报告。
一名54岁女性患者因格子状角膜营养不良接受了右眼PK。PK术后5年，她在外周植片处发生了由近平滑念珠菌和嗜麦芽窄食单胞菌引起的混合性角膜炎，通过局部使用抗生素和抗真菌滴眼液成功治愈。一年后，又发生了另一次真菌性角膜炎，抗真菌治疗后病情明显缓解，但以一种不寻常的方式复发，需要再次进行PK，从而确诊为弯隐球菌角膜炎。这通过在沙氏葡萄糖琼脂上的微生物培养、D1 - D2和内转录间隔区的核糖体重复区域测序以及组织病理学检查得以证实。尝试了各种局部、角膜内和全身抗真菌治疗，但均未能完全消除感染，因此需要进行第三次PK。第三次PK后16个月再次复发，通过多次局部和角膜内抗真菌治疗以及对角膜脓肿进行直接冷冻疗法得以根除。在4年的随访中未再发现弯隐球菌复发。
弯隐球菌应被添加到已知可引起真菌性角膜炎的微生物名单中。我们的经验表明，这种类型的微生物可能导致低度、持续性感染，然而可能极难治疗。通过强化眼部和全身抗真菌治疗、重复治疗性角膜移植术以及局部冷冻疗法，有可能长期根除这种罕见的真菌性角膜炎。
