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Hong, Yun, and Park: Infectious Crystalline Keratopathy Caused by Alternaria
Case Report

Journal of the Korean Ophthalmological Society 2019; 60(11): 1112-1116.

Published online: 19 November 2019

DOI: https://doi.org/10.3341/jkos.2019.60.11.1112

Infectious Crystalline Keratopathy Caused by Alternaria

Hye Jin Hong, MD, Jong Myoung Yun, MD, Dae Jin Park, MD

Department of Ophthalmology, Daegu Fatima Hospital, Daegu, Korea.

Address reprint requests to Dae Jin Park, MD. Department of Ophthalmology, Daegu Fatima Hospital, #99 Ayang-ro, Dong-gu, Daegu 41199, Korea. Tel: 82-53-940-7140, Fax: 82-53-954-7417, dj_oph_2540@hanmail.net

Received 7 June 2019       Revised 4 July 2019       Accepted 23 October 2019

©2019 The Korean Ophthalmological Society

The Korean Ophthalmological Society

(open-access):

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 a case of infectious crystalline keratopathy caused by Alternaria in the corneal center.

Case summary

A 66-year-old male visited our clinic with right ocular pain and visual loss after corneal trauma caused by a foreign body hitting his right eye while performing farm work 1 month prior to his visit. The patient had no history of corneal surgery and long-term use of topical corticosteroid. A corneal epithelial defect and whitish snowflake margin infiltration around the corneal stroma were observed in the corneal center, but there was an absence of conjunctival injection and anterior segment inflammation. Cultures and a biopsy of the corneal scrapings revealed Alternaria species fungus. The patient was treated with 1% topical voriconazole and 0.5% moxifloxacin, together with oral voriconazole (400 mg/day). After 2 months of treatment, the disease was completely cured, with a minute corneal opacity.

Conclusions

We successfully treated a rare case of infectious crystalline keratopathy caused by Alternaria, which has not been previously reported in the Republic of Korea.

Keywords: Alternaria spp., Corneal trauma, Infectious crystalline keratopathy

Figures and Tables

Figure 1

Slit-lamp photography of the right eye at the initial examination. (A) The right eye shows whitish snowflake-like margin of stromal infiltration. (B) Absence of corneal and anterior segment inflammation. (C) Corneal surface of the right eye after corneal biopsy (arrow).

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Figure 2

Pathology slides of the corneal tissue. (A) The KOH mount & Gram stain showed plenty of septate hyphae. (B) Corneal biopsy. The organisms stained positive with Periodic acid Schiff (PAS). PAS stain revealed the microbial colonies aggregated in the stroma (arrow). (C) Corneal biopsy. The organisms stained positive with Grocott's methenamine silver (GMS). GMS stain revealed the microbial colonies aggregated in the stroma (arrow). Original magnification (×200).

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Figure 3

Photograph of Alternaria species cultured on Sabouraud dextrose agar plate (A), stained with lactophenol cotton blue (B). (A) Sabouraud dextrose agar plate Alternaria species showed typical darkly pigmented (dematiaceous) feathery-like light gray colony. (B) On staining with lactophenol cotton blue, branched acropetal chain and macroconidium were seen.

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Figure 4

Slit-lamp photography of the right eye 2 months after treatment. The disease was completely cured, with a minute corneal opacity.

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Notes

This study was presented as an e-poster at the 120th Annual Meeting of the Korean Ophthalmological Society 2018.

Conflicts of Interest The authors have no conflicts to disclose.

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