Scedosporium prolificans Keratouveitis in Association with a Contact Lens Retained Intraocularly over a Long Term

Abstract

Scedosporium prolificans is a soil saprophyte that is associated with a large variety of infectious processes and with respiratory colonization in immunocompetent and immunocompromised patients. We report the first described case of S. prolificans keratouveitis associated with the intraocular long-term retention of a contact lens in a 76-year-old female patient. CASE REPORTA 76-year-old female was seen in February 2000 with an 8-week history of acute keratitis of the left eye. Ten years previously, she had started to wear contact lenses to correct her presbyopia. She wore the lenses for 6 months, at which time she apparently lost them and returned to using eyeglasses. Three days later, the right contact lens was found in the patient's right superior conjunctival fornix and removed. The left contact lens was never found and was believed to have been dislodged on its own. However, the patient started to experience a constant feeling of a foreign body in the left eye with lacrimation and discharges. She was diagnosed with keratitis of the left eye of unknown etiology and was started on ciprofloxacin eye drops after Staphylococcus aureus was isolated from the left corneal scrapings. Although the condition improved, it did not resolve completely, and over the course of the next 10 years the patient received medical management periodically, including a variety of antibiotics, topical steroids, and artificial tears for acute exacerbations of chronic keratitis. The most recent exacerbation occurred in December 1999, when the patient was treated with amoxicillin-clavulanate potassium (Augmentin) orally and a 0.3% tobramycin ophthalmic solution (1 drop four times daily).In February 2000, an examination revealed mild swelling of the left upper eyelid. The eyelid was inverted, and the tarsal border was lifted with a glass rod. A necrotic mass that was easily removed with forceps became visible. The mass had numerous, variously sized, cauliflower-like growths and was covered by a whitish membrane on the superior surface.A portion of the mass was sent for histological examination. Hematoxylin-and-eosin-stained sections of the mass revealed extensive areas of necrotic tissue surrounding the long-lost contact lens. Lymphocytes and plasma cells had infiltrated the periphery of the necrotic tissue around the lens. Septate hyphae within the necrotic tissue were visualized with Grocott methenamine silver nitrate stain (8) (Fig. 1). Gram-positive bacteria were demonstrated with Brown-Hopps Gram stain (3).The ophthalmologist inoculated a portion of the mass directly onto a Trypticase soy agar plate with 5% sheep blood, a chocolate agar plate, thioglycolate broth (for anaerobic culture), and a Sabouraud dextrose agar slant. None of the mass was submitted for direct examination by Gram staining or KOH staining. Additional specimens were submitted in viral transport medium for herpes simplex virus, cytomegalovirus, and Chlamydia trachomatis cultures. These latter cultures never grew.Blood and chocolate agar plates grew S. aureus after o...

Melanized Fungi in Human Disease

“…The organism grows at 40°C, colonies display a striking darkening centrally (both front and reverse), and it produces finely echinulate conidia demonstrating various degrees of spiral banding. It has been reported as an agent of cerebral phaeohyphomycosis in a leukemic child (24), as an agent of keratitis (691), and as an agent of keratouveitis in association with a retained intraocular lens (41 (159). It differs from the former by having pigmented hyphae and conidiophores and from the latter by having indistinct collarettes and warty conidiogenous cells.…”

Infections Caused byScedosporiumspp

“…that have been reported include corneal ulcerations, conjunctival mycetoma, keratouveitis, retinitis, corioretinitis, endophthalmitis, and orbital infections (20,43,210,220,226,227,281,295,364,424,438). Other infections of the eye, such as chorioretinitis, have been reported to have originated in local lymph nodes infected with S. apiospermum (220).…”

Current Perspectives on Ophthalmic Mycoses

“…For example, a fungal strain isolated from a patient with keratitis was initially identified as Arthrobotrys oligospora but later reidentified as Cephaliophora irregularis (128); C. irregularis was subsequently isolated from another patient with keratitis as well (235). Similarly, a filamentous fungus isolated from an intraocular lesion arising out of a retained contact lens was identified as Scedosporium prolificans (19); it now appears that this identification may have been erroneous (J. Guarro To overcome these limitations, reports of single cases or small numbers of patients were considered acceptable for this review if they satisfied criteria similar to those described earlier (237): when an adequate clinical history was presented that suggested a mycotic infection; when the fungus was seen in the clinical specimens; and when the morphology of the fungus in the clinical specimens was consistent with the reported etiologic agent.…”