Guttmann Andreas, Wintersteller Paul, Woltsche Nora, Heidinger Astrid, Medic Ajdnik Nika, Pekovits Karin, Boldin Ingrid, Aminfar Haleh, Horwath-Winter Jutta
Department of Ophthalmology, Medical University Graz, Auenbruggerplatz 4, 8036, Graz, Austria.
Am J Ophthalmol Case Rep. 2025 Jun 28;39:102373. doi: 10.1016/j.ajoc.2025.102373. eCollection 2025 Sep.
Pyrenochaeta unguis-hominis, also known as Neocucurbitaria unguis-hominis, is a rare fungal pathogen typically isolated from skin and nail infections. Recently, it has been identified as a cause of fungal keratitis, particularly among contact lens wearers. This case report documents the occurrence of Pyrenochaeta unguis-hominis keratitis in Austria and the visualization of changes in the corneal stroma using in vivo confocal microscopy (IVCM).
A 48-year-old female patient presented with severe photophobia and acute pain in her left eye, following extended wear of soft contact lenses. Initial examination revealed a central corneal infiltrate. IVCM was performed prior to corneal scraping, which was then sent for direct staining, culture, and next-generation sequencing (NGS) and identified Pyrenochaeta unguis-hominis and Streptococcus oralis. Treatment included hourly topical voriconazole 2 %, natamycin 5 % and vancomycin 2.5 %, with additional epithelial debridement to enhance drug penetration. IVCM imaging allowed for real-time visualization and tracking of structures with the appearance of fungal hyphae, guiding the treatment course. Over several months, IVCM demonstrated a reduction in these structures, and the patient's condition stabilized, resulting in improved corneal clarity and Best Corrected Distance Visual Acuity from 0.8 to 0.9 (Snellen decimal scale).
This case contributes to the limited clinical literature on Pyrenochaeta unguis-hominis-associated keratitis and includes IVCM imaging of a cornea with this rare infection. While IVCM provided early, non-invasive visualization of stromal changes, definitive diagnosis was achieved through molecular testing. A conservative treatment regimen with topical antifungals and epithelial debridement was effective, emphasizing the importance of rapid diagnostics and targeted therapy in managing rare corneal infections.
人爪梨孢菌，也称为人爪新小穴壳菌，是一种罕见的真菌病原体，通常从皮肤和指甲感染中分离出来。最近，它已被确定为真菌性角膜炎的病因，尤其是在隐形眼镜佩戴者中。本病例报告记录了奥地利人爪梨孢菌性角膜炎的发生情况，并使用共聚焦显微镜（IVCM）对角膜基质的变化进行了可视化观察。
一名48岁女性患者在长时间佩戴软性隐形眼镜后，左眼出现严重畏光和剧痛。初步检查发现中央角膜浸润。在角膜刮片之前进行了IVCM检查，然后将刮片送去进行直接染色、培养和二代测序（NGS），鉴定出人爪梨孢菌和口腔链球菌。治疗包括每小时局部使用2%伏立康唑、5%那他霉素和2.5%万古霉素，并进行额外的上皮清创以增强药物渗透。IVCM成像能够实时可视化并追踪出现真菌菌丝外观的结构，指导治疗过程。在几个月的时间里，IVCM显示这些结构减少，患者病情稳定，角膜清晰度提高，最佳矫正远视力从0.8提高到0.9（斯内伦小数视力表）。
本病例为关于人爪梨孢菌相关性角膜炎的有限临床文献增添了内容，并包括了对这种罕见感染角膜的IVCM成像。虽然IVCM提供了角膜基质变化的早期非侵入性可视化，但通过分子检测实现了明确诊断。局部抗真菌药物和上皮清创的保守治疗方案有效，强调了快速诊断和靶向治疗在处理罕见角膜感染中的重要性。
