title: Aspergillus terreus infection in a sutureless self-sealing incision made during cataract surgery.
abstract: Here, we describe a case of keratitis caused by Aspergillus terreus in an 80-year-old immunocompetent woman 1 month after uneventful cataract surgery. The patient presented with decreased visual acuity (20/50) and severe pain in her right eye. Examination revealed a 3.5 × 4.5 mm white-colored deep stromal infiltration located on the temporal corneal tunnel incision. Corneal scraping samples were obtained for cytological and culture examinations. The cinnamon-brown colonies consisting of a dense felt of conidiophores were identified as A. terreus using molecular data. Using CLSI M38-A2 microdilution method, minimum inhibitory concentration values of amphotericin B, itraconazole, voriconazole, and posaconazole were determined to be 2, 1, 0.25, and 1 μg/ml, respectively, and minimum effective concentration values of caspofungin and anidulafungin were ≤0.03 and ≤0.03, respectively, at 48 h for the A. terreus strain. Antifungal therapy was started as topical 1 % voriconazole drops hourly and 5 % natamycin ointment five times a day; however, corneal infection and melting progressed despite the ongoing intensive treatment and visual acuity dropped to the 20/200 level at the end of the first week. Amniotic membrane transplantation was performed to promote corneal healing. Topical medication was tapered and discontinued within 2 months based on the clinical features. The ulcer healed with scarring and vascularization, and visual acuity improved to 20/50. In conclusion, A. terreus is a very uncommon cause of mycotic keratitis and is especially rare after cataract surgery. We suggest that early and accurate diagnosis and appropriate treatment of A. terreus keratitis may have a major impact on preventing severe disease complications.
authors.affiliation: Department of Ophthalmology, Faculty of Medicine, University of Çukurova, Adana, Turkey.
authors.forename: Elif
authors.initials: E
authors.lastname: Erdem
authors.forename: Hazal
authors.initials: H
authors.lastname: Kandemir
authors.forename: Sevtap
authors.initials: S
authors.lastname: Arıkan-Akdağlı
authors.forename: Ebru
authors.initials: E
authors.lastname: Esen
authors.forename: Arbil
authors.initials: A
authors.lastname: Açıkalın
authors.forename: Meltem
authors.initials: M
authors.lastname: Yağmur
authors.forename: Macit
authors.initials: M
authors.lastname: İlkit
mesh_terms: D000369:Aged, 80 and over; D000935:Antifungal Agents / Q000627:therapeutic use*; D001228:Aspergillosis / Q000175:diagnosis* / Q000188:drug therapy* / Q000382:microbiology; D001230:Aspergillus / Q000187:drug effects*; D002387:Cataract Extraction / Q000009:adverse effects*; D003315:Cornea / Q000382:microbiology; D005260:Female; D006801:Humans; D007634:Keratitis / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology; D008826:Microbial Sensitivity Tests; D010866:Natamycin / Q000627:therapeutic use; D065819:Voriconazole / Q000627:therapeutic use
chemical_list: D000935:Antifungal Agents; D010866:Natamycin; D065819:Voriconazole