Scedosporium-induced keratitis: insights from a case study.

Abstract

Introduction: Pseudallescheria boydii with its asexual form, Scedosporium apiospermum, is now recognized as an important emerging opportunistic pheoid-hypomycosis. Usually results in invasive infections in immunocompromised patients but rarely can infect the eyes. Herein, we report a challenging case of Pseudallescheria boydii keratitis in a lady with traumatic injury.

Case report: A 38-year-old female presented with alleged history of penetrating injury to right eye with stick by her spouse for which she was started on antibiotic eye drops from nearby local hospital and became symptomatically better. Later she had alleged history of ashes thrown to her right eye 2 weeks ago. She was referred here from a nearby hospital, with complaints of pain, itching, watering of eye and blurring of vision. On examination, Limbal -limbal ulcer with peripherally thinned out cornea and mucoid discharge was present. Corneal scrapings revealed P boydii. She was managed with antibiotics such as moxifloxacin, tobramycin and antifungals such as Natamycin, fluconazole. She did not improve symptomatically. She was referred to a higher center for keratoplasty and the patient was thus discharged for the same.

Conclusion:  Pseudallescheria boydii is a soil saprophytic, uncommon fungi entering body via respiratory or penetrating injury. It is often mistaken as Aspergillosis, This fungi shows resistance to amphotericin B, flucytosine and susceptible to triazoles. Surgical resection of lesion shows better outcome. The response of disseminated infection to combination therapy with interferon gamma and antifungal agents is encouraging.