Pestalotiopsis mangiferae에 의한 진균성 각막궤양 첫 증례
First Case of Fungal Corneal Ulcer Caused by Pestalotiopsis mangiferae
1경북대학교 의과대학 임상병리학교실
1Department of Clinical Pathology, School of Medicine, Kyungpook National University, Daegu, Korea
2Kyungpook National University Hospital-National Culture Collection for Pathogens, Daegu, Korea
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Lab Med Online 2020; 10(3): 247-249
Published July 1, 2020
Copyright © The Korean Society for Laboratory Medicine.
An 80-year-old male farmer was admitted following ocular pain in the right eye for two weeks. The patient had undergone surgery in both eyes for cataract and glaucoma two years prior to this incident. During initial presentation, the right conjunctiva was injected, and slit-lamp examination showed a 3.0×2.5 mm-sized epithelial defect in the cornea of the right eye, along with corneal thinning. Visual acuity measured via finger counting was 30 cm in the right eye and 0.32 cm in the left eye. Intraocular pressure was not measured in the right eye, but was 9 mmHg in the left eye. KOH examination of corneal scrapings showed the presence of some spores; however, cultures for fungi showed negative results. Bacterial cultures of the corneal scrapings were also performed, and
P. mangiferaecultured in a petri dish containing potato dextrose agar at 30°C for 7 days, displaying delicate, furry, white hyphae with aerial mycelia on the surface.
Figure 2. Microscopic capture of five-celled conidia with three olive-brown median cells, hyaline terminal cells, and branched appendages arising from the apex of the apical cell (lactophenol cotton blue staining, 25°C for 7 days incubation).
Additional 200-mg voriconazole injections were administered twice in a two-week interval. Because the corneal perforation in the right eye did not resolve and visual acuity worsened, the patient was admitted for antifungal treatment and therapeutic penetrating keratoplasty (PKP). At the time of admission, a 3.2×3.2 mm-sized perforated and edematous cornea was observed in the right eye, and the anterior chamber of the right eye had nearly collapsed. Antibiotics (vancomycin, ceftazidime, and voriconazole) were applied to the anterior chamber, and intravitreal irrigation was performed during PKP surgery. Fungal and bacterial routine cultures performed on day 1 after surgery showed no growth. During follow-up in the outpatient clinic, no signs of infection were observed.
Ophthalmic mycoses are being increasingly recognized as an important cause of morbidity and blindness, with keratitis (corneal infection) being the most frequent presentation. Fungi are opportunistic in terms of infecting the eye, since they rarely infect healthy, intact ocular tissues. Even the minor trauma of a dust particle falling onto the cornea can disrupt the integrity of the corneal epithelium, predisposing it to mycotic keratitis . Common fungi that cause corneal infections include species of
Although antifungal agents such as natamycin, amphotericin B, and voriconazole are used to manage fungal keratitis, it is difficult to treat rarely reported fungi due to delayed diagnosis or lack of evidence regarding the susceptibility of the infection to routinely used antifungal agents . In their case, Monden et al. performed antifungal susceptibility tests for
This is the first study to report a corneal
This research was supported by a fund (2019-ER5501-00) by Research of Korea Centers for Disease Control and Prevention.
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