Mycotic keratitis is an ocular infective process derived from any fungal species capable of corneal invasion. Despite its rarity in developed countries, its challenging and elusive diagnosis often result in surgical interventions such as keratoplasty or enucleation following failed medical management or advanced disease at presentation. Filamentous fungi, such as Fusarium are often implicated in mycotic keratitis.
Case report and literature review. Isolate identification and susceptibility testing was performed by the National Micology Reference Centre in Adelaide, South Australia.
We describe a case of resistant keratitis in a 46 year old male. Following exhaustive negative inves-tigations including several corneal swabs, scrapings and biopsies, Fusarium solani complex was fi-nally isolated on operative specimen and identified to be a highly resistant organism to all tested antifungal agents. The patient was initially treated with aggressive and broad antifungal agents in-cluding systemic, topical and intraocular (intracameral, intrastromal and intravitreal) voriconazole and amphoterecin B and topical natamycin. He continued to decline despite maximal therapy, and during therapeutic penetrating keratoplasty, iris involvement was noted. Finally, enucleation was performed as a means of source control preventing dissemination of a likely untreatable fungal in-fection into the orbit
Mycotic keratitis is a challenging diagnosis, bears greater morbidity than its bacterial counterpart, requiring early clinical suspicion and early antifungal therapy to prevent devastating consequences. Multidrug resistant Fusarium is rare, and associated with progression to endophthalmitis. We dis-cuss potential management options which may enhance diagnosis and outcome in this condition.