Open AccessExophiala lecanii-corni keratitis presenting as a serpiginous pigmented superficial lesion: a case report
Author(s) -
Tomoko Miyakubo,
Daisuke Todokoro,
Yoshiyuki Satake,
Koichi Makimura,
Sumiko Miyakubo,
Hideo Akiyama
Publication year - 2020
Publication title -
medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.59
H-Index - 148
eISSN - 1536-5964
pISSN - 0025-7974
DOI - 10.1097/md.0000000000022121
Subject(s) - medicine , voriconazole , keratitis , lesion , cornea , dermatology , ophthalmology , phaeohyphomycosis , natamycin , fungal keratitis , pathology , antifungal
Rationale: Patients with bullous keratopathy (BK) treated by Descemet stripping automated endothelial keratoplasty (DSAEK) have a compromised cornea, due to the administration of topical steroid, postsurgical use of contact lenses, and impaired barrier function of the corneal epithelium by BK. We report a case of Exophiala lecanii-corni ( E lecanii-corni) keratitis presenting as a serpiginous pigmented superficial lesion after DSAEK. Patient concerns: An 81-year-old woman who had undergone cataract surgeries, suffered from decreased vision in the left eye. She was diagnosed BK and she underwent DSAEK. Two months after DSAEK, a pigmented superficial lesion developed on the left cornea. The lesion migrated and recurred repeatedly and she was referred to our department. Best corrected vision was 20/220. Diagnoses: Light microscopy of a corneal scraping revealed branching fungal hyphae. Fungal culture showed growth of a black colony, identified as E lecanii-corni by ribosomal DNA sequencing. Interventions: We started topical treatment with 1% voriconazole and 1.5% levofloxacin. Antifungal susceptibility testing showed that the minimum inhibitory concentration of voriconazole was 0.06 μg/mL. Outcomes: The lesion scarred after treatment for 3 months, and left best corrected vision improved to 20/40. Lessons: Genus Exophiala is known as 1 of the “black molds” and a cause of chromomycosis. This is the first description of E lecanii-corni keratitis, and pigmented corneal epithelial lesions may be characteristic of this fungal genus.