Clinical experiences in fungal keratitis caused by Acremonium
A 64-year old woman injured her left eye with vegetable matter. On examination, biomicroscopy revealed a peripheral corneal epithelial defect, which was surrounded by ring-shaped stromal infiltration with a feathery border (). Corneal scraping showed hyphae. The patient was started on an hourly instillation of topical 0.5% moxifloxacin (Vigamox; Alcon Laboratories, Inc., Fort Worth, TX, USA), 0.15% amphotericin B (Ambisome, Yuhan Corporation, Seoul, Korea), 0.2% fluconazole (Diflucan, Ilyang Pharmaceutical, Seoul, Korea), and oral fluconazole (Oneflu, Joongwea Shinyak, Seoul, Korea), 100 mg twice daily. After 1 week, there was no reduction in the size of the corneal infiltrate (). Corneal cultures were subsequently positive for Acremonium ( and ). The patient was lost to follow-up, but returned 2 weeks later with worsening of the infiltrate and a large epithelial defect (). The cornea was re-scraped to improve the penetration of the topical treatment. Despite hourly treatment with topical eye drops, the patient’s corneal condition failed to improve. We added topical 5% natamycin (Natacyn; Alcon) to the regime. After 2 days, we observed a marked reduction in the size of the infiltrate. Topical amphotericin B and natamycin were gradually tapered over the next 5 weeks. At the final visit, her best-corrected visual acuity (BCVA) was 0.5, and there was no recurrence over the following 6 months ().