Bamahfouz Ashjan Yousef, Alsaidi Abdulrahman Ali, Alharbi Ibrahim Jameel, Elsebaei Eman Abdulraheem, Aldosari Ayat Mohammed, Farahat Ahmed Gamil, Alhazmi Renad Turki
Department of Ophthalmology, College of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia.
Department of Ophthalmology, Security Forces Hospital, Makkah, Saudi Arabia.
Ann Med Surg (Lond). 2020 Nov 27;60:606-609. doi: 10.1016/j.amsu.2020.11.065. eCollection 2020 Dec.
Keratitis caused by saprophytic fungi is on the rise in rural areas, often caused by ocular trauma with wooden objects. Early detection of causative organisms and sustained, supervised management can prevent visual disabilities.
A middle-aged patient from a rural, semi-arid region who presented with pain, redness, and a foreign-body sensation in his left eye resulting from a corneal ulcer induced by trauma from a wooden stick. Due to a history of uncontrolled diabetes and progression of his corneal lesions, he was admitted to our institution for treatment of infectious keratitis. Microbiological examination of corneal scrapings revealed thin, septate hyaline hyphae without conidia or conidiophores, and the patient was diagnosed with a fungal keratitis caused by a species. Though the patient initially responded to treatment with topical natamycin, his condition worsened. He was subsequently successfully treated with topical amphotericin B (1 mg/mL) twice hourly and systemic antifungals. Four months after discharge, the patient returned with symptom recurrence.
We report the case of a patient with a species causing a rare and recurrent fungal keratitis with corneal infiltrates, subsequently cured by medical management with salvaging of his vision. In patients with a suspected fungal keratitis, early treatment is crucial and should be combined with tight glycemic control for as long as 6 months after presentation to avoid recurrence.
腐生性真菌引起的角膜炎在农村地区呈上升趋势，通常由木质物体导致的眼外伤引起。早期发现病原体并进行持续、有监督的管理可预防视力残疾。
一名来自农村半干旱地区的中年患者，因木棍外伤导致角膜溃疡，出现左眼疼痛、发红和异物感。由于有糖尿病控制不佳的病史且角膜病变进展，他被收治到我院治疗感染性角膜炎。角膜刮片的微生物学检查发现了无分生孢子或分生孢子梗的细、有隔膜的透明菌丝，该患者被诊断为由一种 菌种引起的真菌性角膜炎。尽管患者最初对局部使用那他霉素治疗有反应，但病情仍恶化。随后他通过每小时两次局部使用两性霉素B（1mg/mL）和全身抗真菌药成功治愈。出院四个月后，患者因症状复发再次就诊。
我们报告了一例由 菌种引起罕见复发性真菌性角膜炎伴角膜浸润的患者病例，随后通过药物治疗挽救了视力。对于疑似真菌性角膜炎的患者，早期治疗至关重要，并且在就诊后应结合严格的血糖控制长达6个月以避免复发。
