Background:Pediatric mycotic infections in the eye are uncommon. However, ophthalmic
infections by several fungal species have been described in immunocompetent
subjects. Mycotic keratitis with or without conjunctivitis (MK) may account
for more than 50% of all cases, particularly in tropical and sub-tropical
areas. The leading mechanism is trauma. Treatment of MK is managed by
medical (antifungal agents) and/or surgical means. This is the first case
report of a patient with MK by Fusarium spp. successfully
treated with keratoplasty and intravenous voriconazole, along with topical
natamycin.Methods:Keratoplasty was performed and cultures obtained. Both Blood and Sabouraud
Agars were used for cultures, and Lactophenol Cotton Blue Staining for
microscopic observation.Results:A healthy, 10 year-old female, from the sub-tropical area of Sinaloa, Mexico,
was admitted at both the CODET Vision Institute and the General Hospital of
Tijuana, Mexico. Seven days after a direct trauma of the right cornea, the
patient complained of progressive blurred vision, burning sensation, and
itchiness. Clinical examination showed severe keratoconjunctivitis, and a
necrotic slough on the cornea. Fungal colonies grew, and microscopic
visualization showed typical ovoid, sickle-cell shaped macroconidia
characteristics of Fusarium spp. The patient received
intravenous voriconazole (200 mg every 12 h) and topical natamycin for
7 days prior and 6 days after keratoplasty. Topical natamycin was continued
for 3 weeks. At 1-month follow-up, the patient’s outcome was significantly
improved, with 90% vision recovery.Conclusion:This is the first pediatric case report of severe MK by
Fusarium spp. successfully treated with combined
intravenous voriconazole, keratoplasty and topical natamycin.