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Abstract
Purpose
To report a case of Phoma glomerata keratitis occurring in recurrent herpes simplex keratitis cicatrix.
Case summary
A 63-year-old male patient was admitted to our hospital with complaints of abrupt visual deterioration and ocular pain in his left eye. He was treated for recurrent herpes simplex keratitis in the same eye 12 years prior. Because central desmatocele was observed as a result of advanced corneal stromal melting, Gram staining, Potassium Hydroxide (KOH) mount, and culture were performed in corneal scrape specimens. On microbiological evaluation, a Phoma species was detected and Phoma glomerata was diagnosed using DNA sequencing method. Two consecutive amniotic membrane transplantations were performed with topical antifungal agents. The lesion was not improved when using topical amphotericin B and natamycin eyedrops, thus fluconazole eyedrops were used additionally. The corneal infection was resolved with central thick opacification.
Conclusions
In the present case, herpetic keratitis was the main underlying causative factor because the patient had no past history of trauma. When diverse appearances of keratitis occur in herpes simplex keratitis patients, clinicians need to consider the concurrence of fungal infection, especially Phoma glomerata, a rare fungal organism.
References
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Figure 1.
Slit lamp photography of Phoma glomerata keratitis. (A) At initial presentation, descemetocele due to progressive stromal melting was seen at the inferotemporal cornea. Deep and wide circular sulcus was observed around the descemetocele (arrow). (B) and (C) Postoperative 4 days after transplantation of amniotic membrane, dark-brown pigmentations appeared around the corneal lesion (arrow heads). Thinned and protruded cornea were obvious by slitbeam observations. (D) Postoperative 3 months, the lesion was completely healed, but central corneal pigmentation was remained (asterisk).
Figure 2.
Microbiological findings of Phoma glomerata keratitis. (A) The colony of Phoma glomerata on Sabouraud dextrose agar at 25°C for 6 days. Grayish-brown, broadly spreading colonies with sparse aerial mycelium were seen (arrows). (B) Microscopic finding of Phoma glomerata (lactophenol cotton blue stain, × 1000) Chlamydospore, (C) pycnidia.
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