Cladosporium keratitis - a case report and literature review.
BACKGROUND
Fungal keratitis is one of the major causes of infectious keratitis in tropical countries. Symptoms of fungal keratitis consist of blurred vision, redness, tearing, photophobia, pain and foreign body sensation. If not treated effectively, it could lead to blindness. Common causes include Candida spp., Fusarium spp. and Aspergillus spp.. With the limited choices of topical antifungal agents, we were faced with Cladosporium keratitis, a rare cause of fungal keratitis.


METHODS
A 62-year-old Asian male construction worker came to us with intense ocular pain, injection of the conjunctiva, blurred vision, and foreign body sensation in his left eye. His visual acuity was 20/40 OD and 20/400 OS. Slit-lamp exam revealed a corneal ulcer with feathery margin and Descemet's membrane folding. The culture yielded Cladosporium species.. The patient did not show improvements after applying topical natamycin (5 %), topical amphotericin B (1mg/ml), topical fluconazole (2mg/ml) and oral ketoconazole (200mg). After shifting the medical regimen to voriconazole via topical and systemic routes (1mg/ml and 200mg respectively), the keratitis was controlled.


CONCLUSIONS
Fungal keratitis remains a challenge for ophthalmologists as there is no evidence suggesting any particular drug or combination of drugs is more effective than another. A review of common topical antifungal agents was done. Voriconazole could be a good choice for treating corneal infection by Cladosporium species.
Department of Medical Education, Chang Gung Memorial Hospital, No.6, W. Sec., Chia-Pu Rd., Puzi City, Chiayi County, 61363, Taiwan. stevecheng@cgmh.org.tw.
Steve Chih-Hsuan
SC
Cheng
Department of Ophthalmology, Chang Gung Memorial Hospital, No.6, W. Sec., Chia-Pu Rd., Puzi City, Chiayi County, 61363, Taiwan. alice006@cgmh.org.tw.
Ying-Yu
YY
Lin
Department of Ophthalmology, Chang Gung Memorial Hospital, No.6, W. Sec., Chia-Pu Rd., Puzi City, Chiayi County, 61363, Taiwan. k771376@cgmh.org.tw.|Chang Gung University College of Medicine, No.259, Wenhua 1st Rd., Guishan Township, Taoyuan County, 33302, Taiwan. k771376@cgmh.org.tw.
Chien-Neng
CN
Kuo
Department of Ophthalmology, Chang Gung Memorial Hospital, No.6, W. Sec., Chia-Pu Rd., Puzi City, Chiayi County, 61363, Taiwan. lynnlai@cgmh.org.tw.|Chang Gung University College of Medicine, No.259, Wenhua 1st Rd., Guishan Township, Taoyuan County, 33302, Taiwan. lynnlai@cgmh.org.tw.
Li-Ju
LJ
Lai
D000287:Administration, Topical; D000935:Antifungal Agents / Q000627:therapeutic use; D002963:Cladosporium / Q000302:isolation & purification*; D003320:Corneal Ulcer / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D015821:Eye Infections, Fungal / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D066167:Slit Lamp; D014792:Visual Acuity / Q000502:physiology; D065819:Voriconazole / Q000627:therapeutic use
D000935:Antifungal Agents; D065819:Voriconazole