An unusual germ responsible for fungal keratitis: Metarrhizium Anisopliae

Purpose Fungal keratitis remain rare, and often have a poor visual prognosis. About 30% require a keratoplasty. Many fungal agents may be involved. We report the first case of Metarrhizium Anisopliae keratitis in Europe. Methods A 39‐years old man complained about pain and redness in his right eye 15 days after having received earth on his face. His ophtalmologist diagnosed a corneal abscess and initiated a local treatment by Ciprofloxaxin. The patient was referred to our clinic 2 days later for worsening of local abscess. Visual acuity was limited to 2/10 RE and 10/10 LE . Slit‐lamp examination revealed diffuse conjunctival redness, and a 3‐mm diameter corneal abscess surrounded by diffuse corneal edema. After realization of a corneal scraping (which results happened to be negative), we introduced local antibiotherapy (Vancomycin‐Ceftazidim), associated with Amphotericin B and Hexamidin. Despite these treatments and the realization of a therapeutic ptosis for persistent ulcer, the abscess enlarged and a deep stromal infiltration developed. As we suspected a fungal etiology, systemic Voriconazole was added. Despite all these treatments the abscess worsened dramatically and a transfixiant keratoplasty was performed. Results Microbiological analysis of the cornea revealed neither bacteria nor amoeba or viruses, but presence of a filamentous fungus secondary identified as Metarrhizium Anisopliae by molecular biology. Conclusions Metarrhizium anisopliae is usually known as an entomopathogenic fungus. It was first described in human pathology 18 years ago and only 9 cases have been reported worldwide, including 4 cases of keratitis. Our patient is the first case of Metarrhizium Anisopliae keratitis described in Europe. This report also shows that transfixiant keratoplasty is often the only treatment that allows visual rehabilitation in such dramatic cases.