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2002 Ocular Microbiology and Immunology Group, Abstract 17

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Unusual Plaque Presentation of Dematiaceous Fungal Keratitis : A Clinical and Histopathologic Study
Prashant Garg, MD, Geeta K. Vemuganti, MD, Samrat Chatarjee, MD, Usha Gopinathan, PhD, Rishita Nutheti, MSc, Gullapalli N. Rao, MD
L.V. Prasad Eye Institute, L.V. Prasad Marg, Banjara Hills, Hyderabad - 500 034.

Purpose: To evaluate the clinical and histopathological features of pigmented plaque-
like presentation of dematiaceous fungal keratitis.

Methods: All microbiology-proven cases of dematiaceous fungal keratitis presenting with the pigmented plaque were included in the study. The plaque was removed surgically by superficial keratectomy unless contraindicated and was subjected to histopathological examination. The clinical, microbiology and histopathology data were compared with a control group comprising dematiaceous fungal keratitis cases presenting with clinical features other than the plaque.

Results: The entire series consisted of 33 eyes, of which 'plaque' was seen in 15 eyes (group 1) and diffuse keratitis without plaque lesion in 18 eyes (group 2). The median duration of symptoms was 30 days in group 1 (range 7-60 days, mean 27.6 ± 15.6) compared to 12.5 days in group 2 (range 4-90 days, mean 20.17 ± 20.93) (P = 0.048) but the keratitis was less severe in the former. Microbiology showed pigmented septate fungal filaments on smear examination in 66.7 % cases in group 1 compared to 5.6% in group 2 where non-pigmented filaments predominated (83.3%). Histopathology revealed a carpet of pigmented fungal filaments on the corneal surface associated with mild to moderate inflammation (n = 11, 84.7%), and absence of tissue necrosis in group 1 compared to the diffuse spread of the non-pigmented fungal filaments into deeper layers (n = 10, 62.5%), severe inflammation (n = 14, 77.8%), and stromal necrosis (n = 17,94.4%) in group 2.

Conclusions: The unique plaque-like presentation of dematiaceous fungal keratitis represents surface colonization of fungal filaments, associated with expression of pigmentation in the fungal cell wall and mild to moderate inflammation in the underlying corneal stroma.

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