Pythium insidiosum keratitis in contact lens wear: a case report.
OBJECTIVE
The purpose of this study was to report a case of contact lens-related Pythium insidiosum corneal ulcer.


METHODS
The authors conducted an interventional case report. We report the clinical presentations, histopathologic findings, and treatments of a patient with P. insidiosum keratitis associated with contact lens wear.


RESULTS
A 22-year-old Thai woman presented to our clinic with a nonresponsive, progressive corneal ulcer of the left eye. Slit lamp examination showed a large central ulcer measuring 5.4 x 5.2 mm with underlying dense stromal infiltrates surrounded by subepithelial and superficial stromal opacity in a reticular pattern along with radial perineural-like infiltrates. Histopathologic examination revealed broad, branched, thin-walled nonparallel hyaline hyphae with rare septates consistent with P. insidiosum. The corneal culture confirmed the diagnosis. The infection recurred after multiple therapeutic penetrating keratoplasties. Enucleation was eventually performed to eradicate the infection. No definite report of contact lens-related P. insidiosum keratitis existed in the literature.


CONCLUSIONS
Pythium keratitis may present with central ulcer and radial keratoneuritis similar to acanthamoeba keratitis. Contact lens wear can be a risk factor for this infection. Increasing awareness, early diagnosis, and intervention may improve the prognosis.
Lekhanont
Kaevalin
K
Department of Ophthalmology, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Chuckpaiwong
Varintorn
V
Chongtrakool
Piriyaporn
P
Aroonroch
Rangsima
R
Vongthongsri
Anun
A
D000890:Anti-Infective Agents / Q000008:administration & dosage; D003263:Contact Lenses, Hydrophilic / Q000009:adverse effects*; D003320:Corneal Ulcer / Q000188:drug therapy / Q000209:etiology; D004209:Disposable Equipment; D004334:Drug Administration Schedule; D015353:Eye Enucleation; D005260:Female; D024841:Fluoroquinolones / Q000008:administration & dosage; D000077734:Gatifloxacin; D006801:Humans; D007634:Keratitis / Q000209:etiology* / Q000473:pathology / Q000601:surgery; D015948:Keratoplasty, Penetrating; D009883:Ophthalmic Solutions; D011775:Pythium / Q000302:isolation & purification; D012008:Recurrence; D012086:Reoperation; D055815:Young Adult
D000890:Anti-Infective Agents; D024841:Fluoroquinolones; D009883:Ophthalmic Solutions; D000077734:Gatifloxacin