Consultant Cataract, Cornea and Refractive Services, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Pondicherry, India.
Sadguru Chikitsa Netralaya, Shri Sadguru Seva Sangh Trust, Chitrakoot, Madhya Pradesh, India.
Ocul Immunol Inflamm. 2024 Jul;32(5):583-586. doi: 10.1080/09273948.2023.2179495. Epub 2023 Feb 22.
To describe the first case of keratitis masquerading as dematiaceous fungal keratitis in a seropositive male.
A 44-year-old seropositive male previously treated for acute retinal necrosis presented with pain and defective vision in the right eye following a mud injury 5 days back. Presenting visual acuity was hand movements close to the face. Ocular examination revealed a 7 × 7 mm dense, greyish-white mid stromal infiltrate with pigmentation and few tentacles. The clinical diagnosis suggested fungal keratitis. Corneal scraping on 10% KOH and Gram stain revealed slender, aseptate hyaline hyphae. Before culture results, the patient was treated with topical 5% natamycin and 1% voriconazole, but the infiltrate progressed. Culture on 5% sheep blood agar revealed white fluffy, submerged, shiny, and appressed colonies, and insidiosum was confirmed by zoospore formation. The patient was further managed with topical linezolid 0.2% hourly, azithromycin 1% hourly, and adjuvant drugs.
This is an uncommon presentation of keratitis masquerading as dematiaceous fungal keratitis in an immunocompromised male.
描述首例血清阳性男性伪装为暗色真菌性角膜炎的角膜炎病例。
一名 44 岁的血清阳性男性曾因急性视网膜坏死接受治疗，5 天前因眼部受到泥土伤害而出现右眼疼痛和视力下降。目前的视力为眼前手动。眼部检查显示 7×7mm 密度大、灰白色中基质浸润，伴色素沉着和少量触须。临床诊断为真菌性角膜炎。角膜刮片在 10%KOH 和革兰氏染色下显示出纤细、无隔的透明菌丝。在培养结果出来之前，患者接受了局部 5%那他霉素和 1%伏立康唑治疗，但浸润仍在进展。在 5%绵羊血琼脂上的培养显示出白色蓬松、浸没、有光泽和紧贴的菌落，并通过游动孢子形成确认了 感染。患者进一步接受局部利奈唑胺 0.2%每小时、阿奇霉素 1%每小时和辅助药物治疗。
这是一例免疫功能低下男性伪装为暗色真菌性角膜炎的不常见角膜炎表现。
