Fungal Keratitis Caused by Scedosporium apiospermum in an Immunocompetent Patient: How Challenging Can Treatment get?

Abstract

This case report underscores the complexities in managing fungal keratitis caused by Scedosporium apiospermum, even in an immunocompetent patient. The pathogen's resistance to many antifungal agents, its ability to invade deep ocular structures, and the presence of posterior chamber involvement added to the treatment challenges. Effective management requires not only timely diagnosis and targeted antifungal therapy, such as voriconazole, but also careful consideration of adjunctive treatments like corticosteroids and surgical interventions to address inflammation and posterior chamber involvement. In such cases, timely diagnosis is critical. Given the challenges associated with accurate identification through routine mycological diagnostic methods and the limitations of reference spectral libraries for MALDI-TOF MS, the prompt application of molecular techniques should be regarded as the gold standard for Scedosporium spp. typing in instances of clinical suspicion. This approach facilitates rapid and targeted therapeutic interventions.