title: [Fungal dacryocystitis with cacosmia after penetrating keratoplasty--taxonomy and identification of pathogenic fungi based on DNA sequence analysis].
abstract: METHODS
  A 76-year-old woman with a history of penetrating keratoplasty had cacosmia associated with dacryocystitis. Two species of yeast-like fungi were isolated from the contents of her lacrimal sac. Each cultured fungus had a unique, distinctive odor. Althogh treated with an oral antifungal agent and washing of the nasolacrimal duct, the cacosmia was not improved. The continuous dacryocystitis with cacosmia was treated by dacryocystectomy. Two yeast-like fungi were again isolated from the contents of the lacrimal sac. Pathological examination confirmed a diagnosis of fungal dacryocystitis based on the fungal hyphae observed on the excised lacrimal sac wall. The cacosmia promptly disappeared. The fungi isolated from the contents of lacrimal sac were identified by DNA sequencing as Wickerhamomyces anamalus (Pichia anomala-Candida pelliculosa) and Galactomyces geotrichum (Geotrichum candidum).
  
  
  CONCLUSIONS
  The cause of cacosmia in the present case was fungal dacryocystitis. Antibiotic eye drops and steroid eye drops for the treatment of penetrating keratoplasty can cause atypical fungal presentation in the inconsistently treated lacrimal system and can induce dacryocystitis. Careful usage and consideration is necessary in the long-term use of antibiotics and steroids following corneal transplantation.
authors: Department of Medicine and Engineering Combined Research Institute, Asahikawa Medical University, Hokkaido, Japan. hanada@asahikawa-med.ac.jp
authors: Kazuomi
authors: K
authors: Hanada
authors: Naoyuki
authors: N
authors: Miyokawa
authors: Ayako
authors: A
authors: Sano
authors: Sho
authors: S
authors: Igarashi
authors: Akitoshi
authors: A
authors: Yoshida
mesh_terms: D000368:Aged; D016039:Corneal Transplantation / Q000009:adverse effects*; D003607:Dacryocystitis / Q000175:diagnosis / Q000382:microbiology* / Q000601:surgery; D015821:Eye Infections, Fungal / Q000188:drug therapy / Q000382:microbiology* / Q000473:pathology; D005260:Female; D006801:Humans; D015948:Keratoplasty, Penetrating / Q000009:adverse effects*; D000857:Olfaction Disorders / Q000175:diagnosis / Q000382:microbiology* / Q000601:surgery; D017422:Sequence Analysis, DNA / Q000379:methods