A challenging case of candida parapsilosis keratitis

Purpose: To report challenges in the management of a patient with keratitis caused by Candida parapsilosis. Methods: An otherwise healthy 48-year-old man developed chronic corneal ulcer following ocular trauma. Microbiologic work up using smear, culture and In Vivo Confocal Microscopy, was negative. Lamellar and penetrating keratoplasty were performed to cure the infection. Results: The patient developed recurrence of the infection after lamellar keratoplasty. The interface recurrence was seen twice despite washing with antibiotics. Microbial culture finally revealed infection of C. parapsilosis which was sensitive to fluconazole and amphotericin B. Moreover, a repeat lamellar keratoplasty was followed by another recurrence. A penetrating keratoplasty was finally performed with no recurrence of infection during 10 months of follow-up. Conclusions: Diagnosis of the corneal infection by C. parapsilosis can be challenging due to recurrence of the infection after lamellar keratoplasty. A penetrating keratoplasty may be required for cure of yeast infection after repeated recurrence of the infection. In addition, yeast infection should be considered in patients with chronic keratitis.