Dahshan Deena, Francis Charles D, Bitar Maya S
Joan C Edwards School of Medicine, Marshall University, 1600 Medical Center Dr, Huntington, WV, 25701, USA.
School of Medicine & Health Sciences, George Washington University, Ross Hall, 2300 Eye Street, NW, Washington, D.C., 20037, USA.
Am J Ophthalmol Case Rep. 2021 Nov 9;24:101233. doi: 10.1016/j.ajoc.2021.101233. eCollection 2021 Dec.
We present a case of misdiagnosed fungal keratitis due to a bilateral nummular presentation.
A 41-year-old female patient, contact lens wearer, presented initially at an optometrist with acute bilateral blurred vision and photophobia. She was found on exam to have multiple round stromal infiltrates bilaterally. She did not have significant ocular surface issues prior and had no history of topical steroid use. Adenovirus testing was negative, and she was started on a topical antibiotic-steroid combination. She did not improve and was referred for further evaluation. We initially suspected a herpetic infection and began treatment with oral antivirals. Cultures came back positive for in the right eye. She was very photophobic and cultures were unable to adequately be obtained from the left eye. She was switched to topical voriconazole drop in both eyes and gradually improved with excellent visual outcome. Urogenital cultures were negative. Contact lens use was discontinued through the course of treatment.
Bilateral keratitis is rare and has not been reported in a nummular pattern and in a patient without significant ocular surface issues or chronic use of steroid drops. Differential diagnosis of nummular keratitis mostly includes viral and inflammatory conditions. This case highlights the need to stay alert to a possible fungal etiology and a potential risk of using topical steroids at initial presentation of nummular keratitis.
我们报告一例因双侧钱币状表现而被误诊的真菌性角膜炎病例。
一名41岁女性患者，佩戴隐形眼镜，最初因急性双侧视力模糊和畏光就诊于验光师处。检查发现她双眼有多个圆形基质浸润。她之前没有明显的眼表问题，也没有局部使用类固醇的病史。腺病毒检测为阴性，她开始使用局部抗生素 - 类固醇组合药物。她的病情没有改善，因此被转诊进行进一步评估。我们最初怀疑是疱疹感染，并开始使用口服抗病毒药物治疗。右眼培养结果显示 呈阳性。她畏光非常严重，左眼无法充分获取培养样本。她改为双眼使用局部伏立康唑滴眼液，视力逐渐改善，预后良好。泌尿生殖系统培养结果为阴性。在治疗过程中停止使用隐形眼镜。
双侧 角膜炎很少见，尚未有以钱币状模式出现且患者没有明显眼表问题或长期使用类固醇滴眼液的报道。钱币状角膜炎的鉴别诊断主要包括病毒和炎症性疾病。该病例强调了在钱币状角膜炎初诊时需要警惕可能的真菌病因以及使用局部类固醇的潜在风险。
