A case report of Curvularia fungal keratitis

Abstract

Background: Fungal keratitis attributed to ocular trauma is common in developing countries. However, Culvularia species as an etiologic agent is rare and uncommonly described in the literature. We report a case of fungal keratitis caused by Curvularia species that is causing corneal ulcers and scarring.Case Description: A 53 y old forklift truck driver sustained an injury to his left eye while operating his truck. He presented to our Ophthalmology Specialist Clinic with two d' history of sudden onset of left eye redness, pain, and blurring of vision. His left eye examination revealed a fluffy corneal ulcer measuring approximately 2 mm in diameter with satellite lesions, suggestive of fungal corneal ulcer; and no hypopyon in the anterior chamber. His visual acuity over the left eye was 3/60, improved with pinhole testing. Meanwhile, his right eye had a visual acuity of 6/9 and otherwise unremarkable. Corneal scrapping of the ulcer was sent for fungal culture and microscopy. Potassium hydroxide (KOH) and Gram staining showed presence of fungal hyphae. After 7 d of incubation, dark brown velvety colonies were isolated with presence of conidiophores and multicellular, dark brown and slightly curved conidia identified as Curvularia sp. He was treated with topical Ceftazidime, Gentamicin, Fluconazole, and Amphotericin B hourly and oral Amphotericin B daily. At day 18 post-treatment, he was discharged home with topical Fluconazole, topical Amphotericin B and 200 mg oral Fluconazole daily which he completed for 4 w. Unfortunately, although the patient's symptoms subsided and his ulcer healed, he developed corneal scarring that required surgical intervention for improvement of vision.Discussion: Fungal keratitis should be highly suspected in a patient with traumatic ocular injury and correct identification of the causative agent is necessary for targeted therapy which reduces further complications. Rapid screening by Gram stain and KOH wet mount is still the best tool for early fungal keratitis infection although newer modalities such as polymerase chain reaction and noninvasive methods are emerging as more sensitive and specific testing with shorter turn around time.Conclusion: Diagnosis and treatment of fungal keratitis has proven to be challenging. Early diagnosis and treatment is important to prevent visual threatening complications.