Lenticular fungal infection caused by Aspergillus in a patient with traumatic corneal laceration: a case report

Abstract

Background: To report a case of lenticular infection caused by Aspergillus, which was diagnosed 13 weeks after traumatic corneal laceration. Case presentation: A 60-year-old woman presented with traumatic corneal laceration including anterior lens capsule rupture and traumatic cataract after being hit with a chestnut in the right eye. There were multiple injuries due to tiny thorns of the chestnut, including the conjunctiva, sclera, cornea, and anterior lens capsule. But no visible foreign body was detected by slit-lamp examination. Topical corticosteroid was prescribed to resolve the conjunctival inflammation induced by the thorns of chestnut, which could have caused persistent irritation. As conjunctival injection and edema being decreased during outpatient clinical follow-up, embedded conjunctival foreign body was detected and surgically removed (1st surgery). Approximately 10 weeks after the trauma, severe inflammation of the anterior segment accompanied with hypopyon developed suddenly and at the same time embedded scleral foreign body was revealed. After removal of scleral foreign body (2nd surgery), unspecified mold species was cultured from the scleral foreign body in SDA (Sabouraud dextrose agar) plate. Suspicious corneal foreign body was removed as 3rd surgery and phacoemulsification of traumatic cataract was planned as 4th surgery. Aspergillus was finally detected from removed anterior capsule and fibrotic membrane during the operation. Fungal infection resolved successfully after administration of topical (1% voriconazole and 5% natamycin) and systemic (fluconazole) antifungal agents and phacoemulsification of traumatic cataract. Conclusion: Chestnut thorns can damage multiple ocular tissues simultaneously. Lens capsular rupture could result in fungal inoculation and lead to delayed lenticular fungal infection with complicated cataract formation. In cases of ocular trauma due to organic substances such as thorns and branches, the possibility of fungal infection should be considered.

Intraocular foreign body presenting as recalcitrant hypopyon anterior uveitis

“…Exogenous fungal infections typically have a latency period lasting weeks to months; this is unlike bacterial infections, which usually present within days. In a case report by Hwang et al .,[ 5 ] a fungal mass appeared in the AC 10 weeks after the occurrence of trauma; moreover, the formation of whitish exudates in the AC suggested a probable fungal etiology. Our case was similar in that time since injury from a metallic IOFB was 5 months and the presence of exudates in the AC aroused the suspicion of a fungal etiology.…”

Diagnosis and Treatment of Multiorgan-Penetrating Injuries to the Head and Neck: Case Series

“…Fungal infections are rare but should be considered, especially in cases of injuries from foreign bodies such as thorns and branches. 6 Besides, the patient should be injected with tetanus globulin if the penetrating injuries were deep and heavily polluted.…”