Three Cases of Secondary Fungal Infection in Herpes Simplex Keratitis

Gui Hyeong Mun; Yeoung Geol Park; In Cheon You; Kyung Chul Yoon

doi:10.3341/jkos.2010.51.9.1271

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Mun, Park, You, and Yoon: Three Cases of Secondary Fungal Infection in Herpes Simplex Keratitis

Original Article

J Korean Ophthalmol Soc 2010;51(9):1271-1275.

Published online: 7 September 2010

DOI: https://doi.org/10.3341/jkos.2010.51.9.1271

Three Cases of Secondary Fungal Infection in Herpes Simplex Keratitis

Gui Hyeong Mun, MD¹, Yeoung Geol Park, MD¹, In Cheon You, MD², Kyung Chul Yoon, MD¹

¹Department of Ophthalmology, Chonnam National University Medical School, Gwangju, Korea

²Department of Ophthalmology, Chonbuk National University Medical School, Jeonju, Korea

Address reprint requests to Kyung Chul Yoon, MD Department of Ophthalmology, Chonnam National University Medical School & Hospital #8 Hak-dong, Dong-gu, Gwangju 501-757, Korea Tel: 82-62-220-6742, Fax: 82-62-227-1642, E-mail: kcyoon@chonnam.ac.kr

Received 31 March 2010 Accepted 22 May 2010

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To report several cases of secondary infection by fungus in herpes simplex keratitis.

Case summary

A retrospective chart review was performed on 3 eyes of 3 patients who were without improvement and diagnosed with fungal keratitis by smear and culture on prior presentation with herpetic keratitis. Two cases were diagnosed with fungal keratitis, based on the results of culture. Fungal keratitis by Candida albicans was improved with antifungal agents, but a case caused by Fusarium species was more aggravated, regardless of antifungal agents. One case was improved by antifungal medications, which was diagnosed with fungal keratitis by the fungal hyphae manifestation on KOH preparation.

Conclusions

Secondary microbial infection should be considered, when the lesion had no improvement with antiviral agents in herpetic keratitis.

Keywords: Fungus, Herpetic keratitis, Secondary infection

References

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Figure 1.

Case 1. (A) At the initial visit, slit lamp photograph showed 2.0×1.5 mm sized geographic ulcer and stromal infiltration with hypopyon. (B) After 2 weeks, stromal infiltration associated with epithelial defect and hypopyon increased. (C) After 4 months of antifungal treatment, corneal lesions regressed.

Figure 2.

Case 2. (A) At the initial visit, slit lamp photograph revealed dendritic lesion in the upper paracentral cornea. (B) After 2 weeks, stromal infiltration and hypopyon increased. (C) After 6 months of antifungal treatment, corneal lesions regressed.

Figure 3.

Case 3. (A) At the initial visit, slit lamp photograph showed corneal edema with grographic ulcer and linear hypopyon in the left eye. (B) After 1 month, epithelial defect, stromal infiltration and hypopyon increased. (C). After 3 months, the corneal lesions regressed completely.

Table 1.

Clinical characteristics of patients with fungal infection after herpetic keratitis

Case	Age/sex	x Type of HSK^*	Past history	Initial visual acuity	Initial treatment	Smear & Culture	Topical antifungal agent	Other treatment	Final visual acuity
1	73/F	Geographic epithelial keratitis, endotheliitis	DM^†	0.15	Topical gancyclovir, Gatifloxacin, Oral acloclovir, Oral steroid	Candida albicans	Amphotericin-B, Voriconazole	−	0.2
2	54/F	Dendritic epithelial keratitis		FC^‡ 50 cm	Topical acyclovir, Gatifloxacin, Oral acloclovir	Fusarium species	Fluconazole, Amphotericin-B	AMT^§	HM
3	64/M	Geographic epithelial keratitis, endotheliitis	HTN^∏, HSK	HM^＃	Topical acyclovir, Gatifloxacin, Oral acyclovir, Oral steroid	Fungal hypahe	Voriconazole	AMT	FC 30 cm

^* Herpes simplex keratitis

^† Diabetes mellitus

^‡ Fingers counting

^§ Amniotic membrane transplantation

^∏ Hypertension

^＃ Hand movement.

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