Uso de voriconazol tópico en queratitis por alternaria

Abstract

RESUMENCaso clínico: Hombre de 38 años remitido de otro centro por presentar queratitis fúngica por Alternaria 25 días después de realizarle una queratoplastia penetrante postraumática en ojo derecho. Se instaura tratamiento con voriconazol tópico y oral con buena evolución posterior. Discusión: Las queratitis fúngicas por Alternaria son poco frecuentes. Su tratamiento es difícil porque la evolución clínica no se correlaciona con la susceptibilidad in vitro del hongo. Producen cuadros clínicos que requieren un rápido diagnóstico y tratamiento, para evitar la pérdida de visión. La combinación de voriconazol tópico y sistémico puede ser una buena alternativa en caso de hongos resistentes al tratamiento convencional.Palabras clave: Queratitis fúngicas, queratitis resistentes, voriconazol tópico, Alternaria, queratoplastia penetrante. COMUNICACIÓN CORTA ABSTRACTClinical case: A 38-year-old man with fungal Alternaria keratitis was referred from another hospital 25 days after post-traumatic penetrating keratoplastia surgery on his right eye. We commenced treatment with topical voriconazole and the condition resolved. Discussion: Fungal Alternaria keratitis is rare, and treatment is difficult because the clinical response does not correlate well with the antibiotic in vitro sensitivity of the fungus. Clinical cases need to be diagnosed and treated quickly if visual loss is to be avoided. The combination of topical and systemic voriconazole has been shown to be an effective treatment for this condition (Arch Soc Esp Oftalmol 2008; 83: 493-496).

Alternaria keratitis after deep anterior lamellar keratoplasty

“…It has been associated with a spectrum of fungal species such as Aspergillus , Funsarium and Candida in addition to rare types such as dematiaceous fungi including Alternaria and Curvularia 1235. The occurrence of fungal keratitis has been associated with many risk factors such as ocular trauma, diabetes, surgery and use of topical corticosteroids and antibiotics 1…”

“…Aspergillus and Fusarium are two of the most common pathogenic fungi isolated 2234. De-Domingo-Barón et al 1.…”