title: Aspergillus keratitis in vernal shield ulcer--a case report and review.
abstract: An unusual case of vernal shield ulcer with superadded fungal keratitis caused by Aspergillus fumigates is reported. A 26-year-old man, a known case of vernal keratoconjunctivitis (VKC) presented with the complaint of diminution of vision in the right eye. Patient was on topical steroids and anti-allergic treatment for the past two months. In the right eye, a shield ulcer with an elevated plaque was seen. Scrapings from the right cornea revealed fungal filaments on a wet KOH mount and culture revealed growth of Aspergillus fumigatus. The patient was diagnosed as VKC with shield ulcer with secondary fungal keratitis. The patient was treated with topical cyclosporine, topical moxifloxacin, topical natamycin, and topical amphotericin eye drops. The patient responded well and finally recovered to a best spectacle-corrected visual acuity of 20/20 at the end of nine months. The chronic ocular surface changes and induced inflammation in VKC, and the instillation of topical steroids for therapy, may create an environmental milieu favorable for fungal keratitis. Microbiological evaluation should be considered, even in cases of suspected sterile keratitis, to prevent possible worsening of an associated infective corneal condition. This warrants patient education, periodic reviews and a very cautious approach to indiscriminate use of topical corticosteroids in cases of VKC with shield ulcer. In the event of any secondary fungal infection, use of steroid sparing topical agent, for example cyclosporine may be considered.
authors.affiliation: Department of Cornea and External Diseases, Aditya Jyot Eye Hospital Pvt Ltd, Major Parmeshwaran Road, Wadala, Mumbai, 400031, India. docvandanajain@rediffmail.com
authors.forename: Vandana
authors.initials: V
authors.lastname: Jain
authors.forename: Kanupriya
authors.initials: K
authors.lastname: Mhatre
authors.forename: Akshay G
authors.initials: AG
authors.lastname: Nair
authors.forename: Debraj
authors.initials: D
authors.lastname: Shome
authors.forename: Sundaram
authors.initials: S
authors.lastname: Natarajan
mesh_terms: D000328:Adult; D018926:Anti-Allergic Agents / Q000008:administration & dosage / Q000009:adverse effects; D000890:Anti-Infective Agents / Q000008:administration & dosage; D000935:Antifungal Agents / Q000008:administration & dosage; D001228:Aspergillosis / Q000139:chemically induced / Q000188:drug therapy; D003233:Conjunctivitis, Allergic / Q000150:complications / Q000382:microbiology* / Q000473:pathology* / Q000628:therapy; D003320:Corneal Ulcer / Q000150:complications / Q000188:drug therapy / Q000382:microbiology* / Q000473:pathology*; D003646:Debridement; D004334:Drug Administration Schedule; D005139:Eyeglasses; D006801:Humans; D008297:Male; D009883:Ophthalmic Solutions; D013256:Steroids / Q000008:administration & dosage / Q000009:adverse effects; D016896:Treatment Outcome; D014786:Vision Disorders / Q000209:etiology; D014792:Visual Acuity
chemical_list: D018926:Anti-Allergic Agents; D000890:Anti-Infective Agents; D000935:Antifungal Agents; D009883:Ophthalmic Solutions; D013256:Steroids