title: Fungal keratitis in a daily disposable soft contact lens wearer.
abstract: OBJECTIVE
  To report the first case of fungal keratitis in a patient wearing daily disposable soft contact lenses.
  
  
  METHODS
  Case Report. A 20-year-old white female in good health developed a corneal ulcer in her lefteye associated with daily disposable soft contact lens wear. There was no history of trauma to the left eye, and she denied overnight wear. Corneal scrapings were taken, and the patient was started on intensive tobramycin 14 mg/mL and cefazolin 50 mg/mL topical therapy for suspected bacterial keratitis. After 3 days of antibacterial therapy, the ulcer worsened. The cultures were negative as were the Gram stain and Gomori's methenamine silver stain. Initial cultures and stains were then repeated with the addition of a culture for herpes simplex virus. The developing clinical picture was suspicious for fungal keratitis. The patient was then started on intensive vancomycin 2%, natamycin 5%, and continued on fortified tobramycin. Three days after the second corneal scrapings were performed, a positive fungal culture was obtained for Fusarium sp. Vancomycin and tobramycin were then discontinued and amphotericin B 0.15% was added to natamycin 5% with the continuation of intensive topical therapy.
  
  
  RESULTS
  The patient's keratitis was successfully treated with intensive double antifungal therapy.
  
  
  CONCLUSIONS
  Infectious keratitis in daily disposable soft contact lens wear is an unusual occurrence. To our knowledge, there is no previous case of fungal keratitis occurring in patients wearing daily disposable lenses. This case emphasizes the importance of considering fungus in the differential diagnosis for keratitis even in daily disposable contact lens wearers.
authors.affiliation: Department of Ophthalmology, Cornea and External Disease Service at the University of Florida, Gainesville, USA.
authors.forename: D M
authors.initials: DM
authors.lastname: Choi
authors.forename: M H
authors.initials: MH
authors.lastname: Goldstein
authors.forename: A
authors.initials: A
authors.lastname: Salierno
authors.forename: W T
authors.initials: WT
authors.lastname: Driebe
mesh_terms: D000328:Adult; D000666:Amphotericin B / Q000627:therapeutic use; D003263:Contact Lenses, Hydrophilic / Q000382:microbiology*; D003315:Cornea / Q000382:microbiology; D004209:Disposable Equipment / Q000382:microbiology*; D004359:Drug Therapy, Combination / Q000627:therapeutic use; D015821:Eye Infections, Fungal / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology; D005260:Female; D005670:Fusarium / Q000302:isolation & purification*; D006801:Humans; D007634:Keratitis / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D009181:Mycoses / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology; D014640:Vancomycin / Q000627:therapeutic use
chemical_list: D014640:Vancomycin; D000666:Amphotericin B