Fungal Keratitis Due to Exophiala Phaeomuriformis
Narrative Responses:
Purpose
Corneal infections, particularly fungal keratitis due to rare fungal species pose a diagnostic and therapeutic challenge due to difficulty in identification and varying susceptibility profiles. We report a case of keratitis due to a very rare fungus, Exophialia phaeomuriformis.
Methods
We report the clinical findings and correlation to microbiological and in vivo confocal images of a case of fungal keratitis due to a new microorganism.
Results
An 84 yo female presented with pain, redness, and broken sutures from previous penetrating keratoplasty (PK) in left eye. Slit lamp microscopy revealed corneal ulcer with pigmented infiltrates, hypopyon, and possible endophthalmitis. Anterior chamber and vitreous taps were done. Growth of black yeast on culture, fungal elements on in vivo confocal microscopy and DNA sequencing led to the diagnosis of Exophiala phaeomuriformis keratitis. The patient did not respond to topical or intravitreal antibiotics and required urgent PK. After surgery, the infection was successfully treated and vision improved from hand movements to 20/100. No recurrence was observed in 1 year follow up.
Conclusion
Fungal keratitis due to Exophialia phaeomuriformis has not been reported so far in literature possibly due to the difficult diagnosis and typing of species. Culture and in vivo confocal microscopy are able to show specific patterns for this microorganism. High suspicion should be kept when culture shows black yeast.