title: Fungal keratitis secondary to Scedosporium apiospermum infection and successful treatment with surgical and medical intervention.
abstract: To report a rare case of severe fungal keratitis caused by Scedosporium apiospermum, which was treated with a penetrating tectonic keratoplasty and aggressive medical treatment. A 62-year-old woman with a history of soil contamination of the right eye while planting vegetables presented with a severe corneal abscess and ocular pain. The patient received medical treatment and underwent tectonic keratoplasty. Both corneal scrapings and the corneal button were evaluated microscopically. The samples were sent for aerobic and anaerobic bacterial and fungal cultures. Microbiological examinations showed S. apiospermum. The isolate was sensitive to amphoterycine B, caspofungin, voriconazole, and resistant to fluconazole. No clinical improvement was achieved with topical voriconazole, vancomycin, ceftazidime, and systemic voriconazole. A penetrating tectonic keratoplasty and lensectomy with continuation of anti-fungal therapy achieved satisfactory results. A fungal etiology should be suspected in a progressive and untreatable corneal abscess. Microbiological investigation is very important in early diagnosis. Despite early diagnosis and aggressive treatment, in selected cases removing the infected tissue surgically is vital in preserving the ocular globe and vision.
authors.affiliation: Department of Ophthalmology, Gazi University, School of Medicine, Ankara, Turkey, burcinkepez@hotmail.com.
authors.forename: Burcin
authors.initials: B
authors.lastname: Kepez Yildiz
authors.forename: Murat
authors.initials: M
authors.lastname: Hasanreisoglu
authors.forename: Zeynep
authors.initials: Z
authors.lastname: Aktas
authors.forename: Gulsah
authors.initials: G
authors.lastname: Aksu
authors.forename: Burcak Comert
authors.initials: BC
authors.lastname: Kocak
authors.forename: Fikret
authors.initials: F
authors.lastname: Akata
mesh_terms: D000935:Antifungal Agents / Q000627:therapeutic use; D016039:Corneal Transplantation; D015821:Eye Infections, Fungal / Q000382:microbiology*; D005260:Female; D051639:Gardening; D006801:Humans; D007634:Keratitis / Q000382:microbiology*; D008875:Middle Aged; D021681:Scedosporium / Q000302:isolation & purification*; D016896:Treatment Outcome
chemical_list: D000935:Antifungal Agents