Fusarium Endophthalmitis: About a Case of Enucleation

Abstract

Fungal eye damages are rare but severe diseases that cause corneal opacity and blindness. The most common pathogens of such damages are Fusarium and Aspergillus. Fusarium is ubiquitous mold found commonly in soil and organic debris. The risk factors for fungal eye damages are trauma (plants, soil, metallic or foreign bodies), corneal surgery (keratoplasty), disruption of corneal epithelium, contact lens wear, and immunosuppressed patients. Clinical suspicion of fungal keratitis is helpful because the diagnosis is difficult to reach based on a laboratory verification, with corneal scraping in adequate culture medium and PCR. Fusarium sp are generally resistant to most antifungal drugs. Despite medical therapy with topical natamycin and voriconazole, surgery is often required with antifungal intracorneal injection, corneal transplantation, and enucleation. A 37-year-old patient presented with a trauma of cornea with a metallic piece was examined in this study. Nine months after local treatment, he complained of painful ocular lesion with a hypopyon. He was treated by intravitreal injection of vancomycin. A corneal scrapping showed hyphae of Fusarium proliferatum. He was treated with amphotericin B and voriconazole; however, no convincing efficacy was achieved and the unbearable eye pain persisted and, unfortunately, he was diagnosed with hepatic cytolysis. Due to the treatment failure, therefore, the enucleation was required and the pathological examination of the eye was found negative.

Keywords: Fusarium, Endophthalmitis, Keratitis, Cornea Ulcer, Voriconazole, Keratectomy, Enucleation