title: Pseudodendritic fungal epithelial keratitis in an extended wear contact lens user.
abstract: OBJECTIVE
  Pseudodendritic keratitis in a contact lens wearer is generally associated with acanthamoeba keratitis. We report a case of isolated pseudodendritic fungal epithelial keratitis that occurred in an extended wear contact lens user.
  
  
  METHODS
  A 48-year-old woman was evaluated in our clinic for a 36-hour history of left eye pain. She wore extended wear soft contact lenses and frequently rinsed her eyes with tap water. Her left cornea had a paracentral 3-mm area of epithelium with raised ridges in a pseudodendritic pattern. The underlying corneal stroma was normal. A therapeutic and diagnostic corneal scraping of the lesion was performed and sent for Gomori methenamine silver (GMS) staining. The clinical concern was for epithelial acanthamoeba keratitis.
  
  
  RESULTS
  The GMS staining revealed septate fungal hyphae within sheets of corneal epithelium. The patient was started on frequent alternating natamycin (5%) and amphotericin B (0.15%) antifungal eyedrops and exhibited a rapid clinical response. Her keratitis completely resolved, and her vision returned to her baseline of 20/25. Corneal fungal cultures showed no growth.
  
  
  CONCLUSIONS
  Our case is an extremely unusual presentation of fungal keratitis, which rarely presents as a pseudodendritic epithelial keratitis. There are two previous similar case reports initially misdiagnosed as acanthamoeba keratitis. Clinicians should be aware that isolated fungal epithelial keratitis can present as a distinct entity and should be considered in the differential diagnosis of pseudodendritic keratitis. The GMS staining is an excellent diagnostic test in a patient presenting with pseudodendritic keratitis because it allows rapid diagnosis of acanthamoeba and fungal infections.
authors.affiliation: Department of Ophthalmology, University of Florida College of Medicine, Gainesville, FL 32610, USA. robknape@yahoo.com
authors.forename: Robert M
authors.initials: RM
authors.lastname: Knape
authors.forename: Silus P
authors.initials: SP
authors.lastname: Motamarry
authors.forename: Monali V
authors.initials: MV
authors.lastname: Sakhalkar
authors.forename: Sonal S
authors.initials: SS
authors.lastname: Tuli
authors.forename: William T
authors.initials: WT
authors.lastname: Driebe
mesh_terms: D000666:Amphotericin B / Q000008:administration & dosage / Q000031:analogs & derivatives; D000935:Antifungal Agents / Q000008:administration & dosage; D003262:Contact Lenses, Extended-Wear / Q000009:adverse effects*; D003937:Diagnosis, Differential; D004334:Drug Administration Schedule; D015821:Eye Infections, Fungal / Q000188:drug therapy / Q000209:etiology* / Q000473:pathology*; D005260:Female; D006801:Humans; D007634:Keratitis / Q000150:complications / Q000382:microbiology* / Q000473:pathology*; D007635:Keratitis, Dendritic / Q000473:pathology*; D008875:Middle Aged; D010866:Natamycin / Q000008:administration & dosage; D009883:Ophthalmic Solutions; D020127:Recovery of Function; D013194:Staining and Labeling; D014786:Vision Disorders / Q000209:etiology / Q000503:physiopathology
chemical_list: D000935:Antifungal Agents; D009883:Ophthalmic Solutions; C041989:amphotericin A; D000666:Amphotericin B; D010866:Natamycin