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2012 Agenda and Abstracts | < Previous | Next >

2012 OMIG Abstract 19

Multi-species Keratomycoses in a Patient Wearing Contact Lenses on Infliximab
E.C. Pike, R.A. Kuenne, and T.F. Mauger

Wexner Medical Center at the Ohio State University, Havener Eye Institute, Columbus, OH

Purpose: Contact lens wear is a significant risk factor for microbial keratitis. Infliximab is a monoclonal antibody with reported use in the treatment of peripheral ulcerative keratitis in autoimmune diseases. This case illustrates the clinical course of isolated episodes of fungal keratitis from two different, uncommon species in the same eye of a patient wearing soft contact lenses who has Crohn’s disease treated with Infliximab.

Method: Detailed anatomical and microbiologic testing prospectively applied to a single case report.

Results: Patient is a 50 year old male with Crohn’s disease on Infliximab who wears extended-wear soft contact lenses and presented initially with left eye pain, decreased vision, and redness. Cornea culture demonstrated heavy growth of Curvularia species. Initial treatment included amphotericin B 0.3% ophthalmic and fortified antibiotic duotherapy; therapy was transitioned to natamycin 5% ophthalmic due to poor response and the infection demonstrated complete resolution. Patient presented 3 years later with a painful, red left eye with decreased vision. Confocal microscopy demonstrated hyphae and cornea culture grew Alternaria species. The contact lens case was cultured without evidence of microbial growth. The patient was treated with natamycin 5% ophthalmic in addition to fortified antibiotic duotherapy with improvement.

Conclusion: Curvularia and Alternaria species are opportunistic, prevalent in tropical climates, and microscopically distinguishable.  Although there are reports of Infliximab treatment for periphreal ulcerative keratitis in autoimmune diseases, we have found no reported cases of associated uncommon keratomycoses. Contact lens wear is a frequent risk factor and should be a significant consideration in patients on autoimmune disease therapy.

Disclosure: N

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