title: Polymicrobial sclerokeratitis caused by Scedosporium apiospermum and Aspergillus cibarius.
abstract: OBJECTIVE
  The aim of this study was to report the first case of polymicrobial fungal sclerokeratitis caused by infection with both Scedosporium apiospermum and Aspergillus cibarius, and notify the medical community of the possibility of infection caused by A. cibarius in humans.
  
  
  METHODS
  A 78-year-old woman presented to a medical practitioner with epiphora and a purulent discharge in her left eye. After concurrent administration of topical antibiotics and systemic steroids, her symptoms worsened, and she was referred to the Tokushima University Hospital. Because of suspected fungal infection, microscopic examination and cultivation of both corneal and scleral scrapings were performed.
  
  
  RESULTS
  Fungi were observed on microscopic examination, and S. apiospermum was isolated only from the sclera in the early stage of the clinical course. Although administration of an adequate medication regimen comprising topical and systemic antifungal drugs resulted in an improvement in the sclera, keratitis persisted, and the infected sclera was melted. After scleral transplantation, administration of systemic caspofungin and high concentrations of voriconazole solution eye drops resulted in a gradual improvement in keratitis. A strain of filamentous fungus was isolated from the cornea 6 weeks after the cultivation on a Sabouraud agar plate, and it was identified as A. cibarius.
  
  
  CONCLUSIONS
  A. cibarius may infect human tissue. Coinfection of the cornea and the sclera with 2 different species of fungi is likely to follow a complex clinical course.
authors.affiliation: *Department of Ophthalmology, Institute of Health Biosciences, The University of Tokushima Graduate School, Tokushima, Japan; and †Department of Mycosis Research, Medical Mycology Research Center, Chiba University, Chiba, Japan.
authors.forename: Yuki
authors.initials: Y
authors.lastname: Hayashi
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Eguchi
authors.forename: Toshi
authors.initials: T
authors.lastname: Toibana
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Mitamura
authors.forename: Takashi
authors.initials: T
authors.lastname: Yaguchi
mesh_terms: D000368:Aged; D000935:Antifungal Agents / Q000627:therapeutic use; D001230:Aspergillus / Q000302:isolation & purification*; D000077336:Caspofungin; D060085:Coinfection / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D004359:Drug Therapy, Combination; D054714:Echinocandins / Q000627:therapeutic use; D015821:Eye Infections, Fungal / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D005260:Female; D006801:Humans; D007634:Keratitis / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D055666:Lipopeptides; D021681:Scedosporium / Q000302:isolation & purification*; D015423:Scleritis / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D065819:Voriconazole / Q000627:therapeutic use
chemical_list: D000935:Antifungal Agents; D054714:Echinocandins; D055666:Lipopeptides; D000077336:Caspofungin; D065819:Voriconazole