Mixed fungal keratitis of Penicillium species and Acremonium species

Nancy Chen^a, Yuan-Chieh Lee^{a, b, c}

^a Department of Ophthalmology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
^b Department of Medicine, Tzu Chi University, Hualien, Taiwan
^c Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan

Full-Text HTML| Download PDF

Abstract
Mixed fungal keratitis of two different genera has rarely been reported. We described a case of mixed fungal keratitis of Penicillium sp and Acremonium sp. A 67-year-old male developed severe keratitis after undergoing superficial corneal trauma of his right eye while picking herbs (Ficus erecta Thunb. var.) 3 days earlier. Corneal stromal infiltration with a feathery border and a surrounding immunological reaction ring was noted without epithelial defect. Direct smear examination of corneal scraping showed the presence of filamentous fungi, and topical natamycin (5%) hourly was prescribed along with systemic voriconazole. However, hypopyon soon developed. Culture revealed growths of Penicillium sp and Acremonium sp. Combined treatment with topical amphotericin B (0.1%) and natamycin, alternated hourly, and systemic ketoconazole resulted in resolution in a fluctuating course. The culture results were important for the diagnosis of a mixed infection and together with careful follow-up were critical for a good result.

Keywords
Acremonium species; Mixed fungal keratitis; Penicillium species