title: A case of fungal keratitis and onychomycosis simultaneously infected by Trichophyton species.
abstract: BACKGROUND
  Fungal keratitis is difficult to treat that can result in corneal blindness requiring penetrating keratoplasty and in fungal endothalmitis. We report a case of fungal keratitis and onychomycosis simultaneously infected by Trichophyton.
  
  
  METHODS
  A 77-year old male presented with ocular pain, conjunctival injection, and severe loss of vision in his left eye. His best corrected visual acuity was hand movements in the left eye, and slit-lamp examination showed a corneal ulcer with feathery margin and hypopyon. Bacterial and fungal smear/culture showed no organism, and there was no improvement in spite of treatment with topical fortified 5% cefazolin and 2% tobramycin. Trichophyton species was identified by repeated cultures. We found onychomycosis on the patient's foot, where the same fungal species were identified. Regimen was changed to topical itraconazole and systemic intravenous itraconazole. No clinical improvement was observed, so therapeutic penetrating keratoplasty and cryotherapy was done with continuation of antifungal therapy. The graft was clear at postoperative 1 month and no evidence of recurrence was found.
  
  
  CONCLUSIONS
  It is important to identify the pathogen of keratitis because early identification of pathogen causing keratitis provides the appropriate treatment in early phase of keratitis. It is necessary to search for other fungal skin infections such as onychomycosis and athelete's foot considering the fungal keratitis following skin infection. In addition, fungal skin infection including onychomycosis should be treated for prevention of fungal keratitis as soon as possible.
authors.forename: Ki Won
authors.initials: KW
authors.lastname: Jin
authors.forename: Hyun Sun
authors.initials: HS
authors.lastname: Jeon
authors.forename: Joon Young
authors.initials: JY
authors.lastname: Hyon
authors.forename: Won Rynag
authors.initials: WR
authors.lastname: Wee
authors.forename: Wool
authors.initials: W
authors.lastname: Suh
authors.affiliation: Department of Ophthalomology, Hallym University College of Medicine, 948-1 Daerim1-dong, Youngdeungpo-gu, Seoul 150-950, Korea. schinn@hanmail.net.
authors.forename: Young Joo
authors.initials: YJ
authors.lastname: Shin
mesh_terms: D000368:Aged; D000935:Antifungal Agents / Q000008:administration & dosage; D003315:Cornea / Q000382:microbiology* / Q000473:pathology; D016039:Corneal Transplantation / Q000379:methods*; D015821:Eye Infections, Fungal / Q000150:complications / Q000382:microbiology* / Q000628:therapy; D005500:Follow-Up Studies; D005533:Foot Dermatoses / Q000150:complications / Q000188:drug therapy / Q000382:microbiology*; D006801:Humans; D007634:Keratitis / Q000175:diagnosis / Q000382:microbiology* / Q000628:therapy; D008297:Male; D014009:Onychomycosis / Q000150:complications / Q000188:drug therapy / Q000382:microbiology*; D012867:Skin / Q000382:microbiology; D014249:Trichophyton / Q000302:isolation & purification*; D014792:Visual Acuity
chemical_list: D000935:Antifungal Agents