title: Multidrug-resistant Fusarium keratitis: diagnosis and treatment considerations.
abstract: Mycotic keratitis is an ocular infective process derived from any fungal species capable of corneal invasion. Despite its rarity in developed countries, its challenging and elusive diagnosis may result in keratoplasty or enucleation following failed medical management. Filamentous fungi such as Fusarium are often implicated in mycotic keratitis. Bearing greater morbidity than its bacterial counterpart, mycotic keratitis requires early clinical suspicion and initiation of antifungal therapy to prevent devastating consequences. We describe a case of multidrug-resistant mycotic keratitis in a 46-year-old man who continued to decline despite maximal therapy and therapeutic keratoplasty. Finally, enucleation was performed as a means of source control preventing dissemination of a likely untreatable fungal infection into the orbit. Multidrug-resistant Fusarium is rare, and may progress to endophthalmitis. We discuss potential management options which may enhance diagnosis and outcome in this condition.
authors.affiliation: Department of Ophthalmology, Gold Coast Hospital and Health Service, Southport, Queensland, Australia.
authors.forename: Sergio
authors.initials: S
authors.lastname: Sara
authors.affiliation: Department of Ophthalmology, Gold Coast Hospital and Health Service, Southport, Queensland, Australia.
authors.forename: Kendall
authors.initials: K
authors.lastname: Sharpe
authors.affiliation: Department of Ophthalmology, Gold Coast Hospital and Health Service, Southport, Queensland, Australia.
authors.forename: Sharon
authors.initials: S
authors.lastname: Morris
mesh_terms: D026141:Drug Resistance, Multiple, Fungal; D015353:Eye Enucleation; D015821:Eye Infections, Fungal / Q000188:drug therapy* / Q000382:microbiology / Q000601:surgery; D060585:Fusariosis / Q000188:drug therapy* / Q000382:microbiology / Q000601:surgery; D005670:Fusarium / Q000187:drug effects*; D006801:Humans; D007634:Keratitis / Q000188:drug therapy* / Q000382:microbiology / Q000601:surgery; D008297:Male; D008875:Middle Aged