Successful Treatment ofFusarium Keratitis with Cornea Transplantation and Topical and Systemic Voriconazole
2005; Oxford University Press; Volume: 40; Issue: 12 Linguagem: Inglês
10.1086/430062
ISSN1537-6591
AutoresRocus R. Klont, C.A. Eggink, Antonius J. M. M. Rijs, Pieter Wesseling, Paul E. Verweij,
Tópico(s)Ocular Surface and Contact Lens
ResumoA case of invasive Fusarium keratitis in a previously healthy male patient was treated successfully with cornea transplantation and systemic and topical voriconazole after treatment failure with topical amphotericin B and systemic itraconazole.Topical voriconazole was well tolerated, and, in conjunction with the oral administration, it resulted in a high level of the drug in the anterior chamber of the eye (which was 160% of the plasma drug level). Case report.A previously healthy male, aged 23 years, presented to our hospital (Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands) with severe and very painful keratitis of the right eye, which had developed during 1 week.He used daily-wear, disposable contact lenses and had been diving in the Port of Willemstad, Curacao.The local ophthalmologist in Curacao had started treatment with ciprofloxacin, amphotericin B, acyclovir, and atropine 4 days before the patient presented to our hospital.The visual acuity of the affected eye was limited to hand movements at 1 m.The conjunctiva showed severe injection, and a corneal ulcer with an infiltrate measuring 4.5-6.5 mm was present, as was a hypopyon in the anterior chamber of the eye.Direct staining of corneal scrapings showed mycelia, and antifungal treatment was started with a topical amphotericin B 0.5% preparation applied hourly and systemic itraconazole at a dosage of 200 mg administered daily.However, despite this therapy, the infiltrate increased in size and approached the limbal area.Culture of the corneal scrapings grew Fusarium solani with an elevated
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