Keratitis by Scopulariopsis brevicaulis Fungus After LASIK – A Case Report

Abstract

Purpose To describe a rare case of an interface filamentous fungal keratitis and its successful clinical approach and management. Patients and Methods Retrospective case report. Analysis of the patient’s clinical records. Results A healthy 30-year-old woman presenting with complaints of blurred vision, photophobia and intense pain, was previously diagnosed with a suspected unilateral diffuse lamellar keratitis after laser in situ keratomileusis surgery, and accordingly treated with a scheme of oral and subconjunctival corticosteroids. Due to worsening of symptoms, the patient was later referred to our ophthalmology department. Upon examination, a corneal infiltration was observed and a fungal infection was suspected. Treatment with fortified Voriconazole (1%) was initiated and both topical and oral corticosteroids were tapered. The infiltrate resolved after 6 weeks of antifungal topical treatment. Scopulariopsis brevicaulis was isolated on culture media. At the end of follow-up, the uncorrected distance visual acuity was 20/20 with mild scarring. Conclusion Scopulariopsis brevicaulis can be associated with post-laser in situ keratomileusis interface infection. A quick intervention may dictate a good outcome, when combining early suspicion and microbiological diagnosis, and an appropriate conservative management. Furthermore, Voriconazole seems to be effective and safe in the treatment of such cases.

Molecular epidemiology of clinical filamentous fungi in Qatar beyond Aspergillus and Fusarium with notes on the rare species

“…We isolated Scopulariopsis brevicaulis from an ear swab of a patient with unknown clinical condition and a wound swab from another patient with a diabetic foot. Scopulariopsis was previously reported from cases of keratitis, 149–153 otomycosis, 154 , 155 onychomycosis, 156 rhinosinusitis, 157 , 158 and disseminated infections. 159 …”

A Case of Fungal Keratitis Caused by Scopulariopsis brevicaulis

“…Baptista ve ark. (12) , bir lazer ameliyatı türü olan lazer in situ keratomileusis cerrahisi sonrası hastaya tek taraflı yaygın lamellar keratit tanısı konularak oral ve subkonjonktival kortikosteroid ile tedavi edilmiştir. Semptomların kötüleşmesi üzerine hasta muayenesinde kornea infiltrasyonu gözlenmiştir.…”

“…Altı haftalık topikal antifungal tedaviden sonra kornea infiltrasyonu düzeldiği gözlenmiştir. Araştırmacılar sonuç olarak, S. brevicaulis, lazer sonrası in situ keratomileusis enfeksiyonu ile ilişkili olabileceği ve vorikonazol bu tür vakaların tedavisinde etkili olduğu sonucuna varmışlardır (12) . Bunya ve ark.…”

Cutaneous Hyalohyphomycosis and Its Atypical Clinical Presentations in Immunosuppressed Patients

“…In a disseminated infection, Scapulariopsis can present as multiple dark skin lesions on the trunk, as reported in a patient with diffuse large B cell lymphoma, treated with chemotherapy and an autologous stem cell transplant [68]. There has also been a report of keratitis caused by Scopulariopsis following LASIK (laser in situ keratomileusis) [69].…”