Oremosu Jadesola, Ung Lawson, Chodosh James, Cañete-Gibas Connie, Wiederhold Nathan P, Davies Emma C, Bispo Paulo J M
Tulane University School of Medicine, New Orleans, LA, USA; Summer Scholars Program, Department of Ophthalmology, Massachusetts Eye and Ear and Harvard Medical School, Boston, MA, USA.
Department of Ophthalmology, Massachusetts Eye and Ear and Harvard Medical School, Boston, MA, USA; Infectious Disease Institute, Massachusetts Eye and Ear and Harvard Medical School, Boston, MA, USA; Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA.
J Mycol Med. 2023 May;33(2):101384. doi: 10.1016/j.mycmed.2023.101384. Epub 2023 Mar 29.
We present a rare case of recalcitrant fungal keratitis caused by Coniochaeta mutabilis, successfully managed with a course of oral, topical, intrastromal, and intracameral antifungals. A 57-year-old male on their fourth week of treatment for presumed left herpes simplex keratitis presented to clinic with severe left-sided foreign body sensation after gardening in his yard. On examination, a white corneal plaque was observed at 8 o'clock, shown to be a dense collection of fungal hyphae on confocal microscopy. Corneal cultures revealed yeast-like cells, initially identified as Kabatiella zeae by matching 100% identity with K. zeae strains CBS 767.71 and CBS 265.32 in BLASTn search using the internal transcribed spacer (ITS) sequence. Treated for over four months with topical amphotericin B and oral voriconazole without improvement, recourse to intrastromal and intracameral amphotericin B injections, coupled with the application of cyanoacrylate glue to the lesion and a bandage contact lens, led to eventual resolution. The patient subsequently underwent cataract surgery, achieving a BCVA of 20/20 in the eye. Surprisingly, upon further sequence analyses of combined ITS and large subunit ribosomal ribonucleic acid (LSU) and investigation of the K. zeae German strain CBS 767.71, the organism was revealed to be Coniochaeta mutabilis (formerly Lecythospora mutabilis). This means that the correct name for CBS 767.71 and CBS 265.32 is C. mutabilis and should be corrected in the GenBank record to avoid misleading identification in the future. This case also underscores the urgent unmet need for improved molecular diagnostic modalities in the care of corneal infections.
我们报告一例罕见的由可变附球菌引起的顽固性真菌性角膜炎，通过口服、局部、基质内和前房内抗真菌药物治疗成功治愈。一名57岁男性，因左眼疑似单纯疱疹性角膜炎接受治疗四周后，在自家院子里园艺劳作后出现严重的左侧异物感，遂到诊所就诊。检查发现，角膜8点钟位置有一个白色斑块，共聚焦显微镜检查显示为密集的真菌菌丝集合。角膜培养发现酵母样细胞，通过使用内部转录间隔区（ITS）序列在BLASTn搜索中与玉米卡氏霉菌株CBS 767.71和CBS 265.32 100%匹配，最初鉴定为玉米卡氏霉。患者接受局部两性霉素B和口服伏立康唑治疗四个多月，病情无改善，随后采用基质内和前房内注射两性霉素B，同时在病变处应用氰基丙烯酸酯胶和绷带式隐形眼镜，最终病情得到缓解。患者随后接受了白内障手术，患眼最佳矫正视力达到20/20。令人惊讶的是，对ITS和大亚基核糖体核糖核酸（LSU）进行进一步序列分析，并对玉米卡氏霉德国菌株CBS 767.71进行研究后发现，该病原体为可变附球菌（原可变梨孢菌）。这意味着CBS 767.71和CBS 265.32的正确名称应为可变附球菌，应在GenBank记录中进行更正，以避免未来出现错误鉴定。该病例还强调了在角膜感染治疗中迫切需要改进分子诊断方法。
