<i>Penicillium</i>keratitis in a HIV-infected patient

A 36-year-old HIV-positive man presented with symptoms of redness, blurred vision and foreign body sensation in his right eye for 3 months. The slit lamp examination revealed deep stromal infiltration with a feathery margin in an otherwise minimal anterior chamber reaction. A corneal scraping was negative. Confocal microscopy demonstrated an abnormal large hyper-reflective oval shape in the corneal stroma. Corneal infiltration did not show improvement after topical, intrastromal and intracameral antifungal treatment. Therapeutic penetrating keratoplasty was performed to eradicate the infection. Corneal button culture and histopathological results confirmed the diagnosis of Penicillium marneffei keratitis. No recurrent infection occurred after corneal transplantation. This appears to be the first report of P. marneffei keratitis in an HIV-infected patient. Although it is an uncommon condition, it should be one of the differential diagnoses in an HIV-infected patient presenting with keratitis

Role of Immunotherapy in Pythium insidiosum Keratitis

ABSTRACT. Pythium keratitis is a potentially devastating ocular condition. Incidence of Pythium keratitis has been reported in tropical and subtropical areas. In previous reports, there were no effective or standard treatments, and combinations of medication, immunotherapy, and surgery were proposed. Pythium insidiosum antigen immunotherapy (PIAI) showed an acceptable safety profile, but its efficacy is questionable in Pythium keratitis. This retrospective review included 10 eyes from 10 patients. All cases were confirmed diagnosis of P. insidiosum keratitis by culture and/or polymerase chain reaction. Three doses of PIAI were injected at 2-week intervals in all patients. The infiltration diameter ranged from 5.2 mm to total corneal involvement, and eight cases (80%) had hypopyon. Therapeutic penetrating keratoplasty (TPK) or scleral graft were undertaken in nine cases. Enucleation was done in one case on the first visit. A second TPK was undertaken in three cases, and two globes were saved. Two cases in the globe salvage group received voriconazole via eyedrops and intracameral injection. No case received either linezolid or azithromycin. Three of nine eye globes (33.33%) were saved. PIAI did not show efficacy in the treatment of Pythium keratitis. Radical surgery including resurgery in recurrence is an approved effective treatment. The recently reported medications may offer supportive management.</jats:p