Severe pigmented keratitis caused by Cladorrhinum bulbillosum

Abstract

We report a case of severe pigmented keratitis with poor prognosis, caused by Cladorrhinum bulbillosum. Antifungal treatment with topical natamycin and fluconazole eye drops and oral tablet fluconazole failed to heal the ulcer and resulted in perforation. The causative fungus, C. bulbillosum, was identified on the basis of its typical microscopic features and 98% sequence homology to ex-type isolate CBS 304.90 (accession no. FM955448). The results of an in vitro antifungal susceptibility test indicated that the isolate was susceptible to natamycin, amphotericin B, fluconazole and itraconazole. The present case is the third case of keratitis and the second case of human keratitis. Compromised immunity due to liver cirrhosis could lead to a failed prognosis even when the fungal isolate is highly susceptible to antifungal treatment.

Filamentous fungal infections of the cornea: a global overview of epidemiology and drug sensitivity

“…The generally applied strategy of sequence‐based molecular identification is the amplification of a fragment from a specific locus by polymerase chain reaction (PCR), followed by sequence determination and analysis of the resulting sequence with a nucleotide–nucleotide BLAST (Basic Local Alignment Search Tool) search in the nucleotide sequence collection of the National Center for Biotechnology Information (NCBI). The application of this approach resulted in the diagnosis of several keratitis cases caused by uncommon filamentous fungal agents, many of them previously unreported from corneal infections (Table ) . These included Lagenidium and Pythium species from the Oomycota division, a series of species from the Botryosphaeriales , Capnodiales , Diaporthales , Eurotiales , Glomerellales , Hypocreales , Microascales , Pleosporales , Sordariales and Xilariales orders of the Ascomycota division, as well as Schizophyllum commune from Basidiomycota .…”

Fungal keratitis: study of increasing trend and common determinants

“…[ 12 ], Acremonium spp. [ 13 ], Cryptococcus albidus [ 14 ]), Pythium insidiosum [ 15 ], Beauveria bassiana [ 16 ], Paecilomyces [ 17 ], Cunninghamella spinosum [ 18 ], Scedosporium apiospermum [ 19 ]), Rhodotorula mucilaginosa [ 20 ], Cylindrocarpon lichenicola [ 21 ], Cladorrhinum bulbillosum [ 22 ]. Lophotrichus species were isolated from the necrotic corneal sample complicating fungal keratitis after dog paw traumatic injury [ 11 ].…”

Histopathological evaluation of chromoblastomycosis: A literature review

“…According to Gajjar et al (2011), obtaining accurate diagnosis of chromoblastomycosis depends mainly on the identification of brown sclerotic bodies or muriform cells, although it should be used with fontanelles such as Fontana Masson and silver methenamine nitrate from Gomori. The process of transepithelial migration of sclerotic bodies and their autoinoculation or even lymphatic dissemination could explain the lesions in the body.…”