Unusual Course of Crystalline Keratopathy in a Patient with Graft-Versus-Host Disease

Abstract

We present a case of infectious crystalline keratopathy in a patient with Graft-versus-Host disease (GVHD) who developed satellite fungal keratitis. A 51-year-old man was referred for bilateral total persistent corneal epithelial defects with severe dry eye. Although persistent epithelial defect healed with medical therapy, he developed stromal keratitis with satellite lesions confirmed to be secondary to Candida albicans. After three months of antifungal treatment and debridement, improvement of the infiltrates was obtained. Crystalline keratopathy is an important clinical entity which may develop due to several causes. The microbial causes include not only bacteria but fungi as well. Careful investigation must be performed, especially for immune-compromised patients, in order to provide appropriate and timely treatment.

Successful Management of Infectious Crystalline Keratopathy with Intrastromal Antibiotic Injections

“…ICK has been classically described in patients with topical immunosuppression following a penetrating keratoplasty (PK) and is notoriously difficult to treat [ 1 , 5 ]. ICK has also been described in patients treated with immunosuppressive agents for other ocular or systemic conditions including Stevens-Johnson syndrome, and chronic graft-vs.-host disease (GVHD) [ 6 , 7 ]. Although local or systemic immunosuppression often precedes ICK, this condition has been linked to neurotrophic corneal diseases such as herpetic keratitis, denervation after corneal surgery (PK [ 2 , 8 ], laser-assisted in situ keratomileusis (LASIK) [ 9 ]), or even after long-term topical anesthetic use [ 10 ] in the absence of immunosuppression.…”