Journal List > J Korean Ophthalmol Soc > v.51(9) > 1008648

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

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.

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.
jkos-51-1271f1.tif
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.
jkos-51-1271f2.tif
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.
jkos-51-1271f3.tif
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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