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2013 Agenda and Abstracts | < Previous | Next >

2013 OMIG Abstract 20

Post-traumatic Fungal Keratitis Due to Neosartorya udagawae: A Case Report
P.A. Ple-plakon1, C. Gupta1, E. Tu2, S.I. Mian1
1Department of Ophthalmology and Visual Sciences, University of Michigan Kellogg Eye Center, Ann Arbor, MI
2Illinois Eye and Ear Infirmary, University of Illinois - Chicago, Chicago, IL

Purpose: To report a case of fungal keratitis secondary to Neosartorya udagawae, a species only recently reported to be pathogenic and with morphological and microscopic similarities to Aspergillus. 

Methods: A healthy 34-year-old male presented with a history of trauma two months prior and a large, central, full-thickness corneal infiltrate. Despite the initiation of aggressive treatment with topical natamycin 5%, topical amphotericin B, topical ciprofloxacin, oral voriconazole, and intrastromal voriconazole, the keratitis progressed to a central corneal perforation, and the patient underwent a therapeutic penetrating keratoplasty. Two weeks later, his graft had a non-healing epithelial defect and signs of rejection with graft slippage, and he was taken back to the OR for a wound revision, amniotic membrane, and lateral tarsorrhapy.

Results: Initial cultures grew Aspergillus, and later Neosartorya udagawae was isolated from two independent laboratories. Species was resistant to natamycin (MIC 8 ug/ml) and fluconazole (MIC 64 ug/ml), while it was sensitive to amphotericin B (MIC 1 ug/ml), voriconazole (MIC 1 ug/ml), anidulafungin (MIC <0.015 ug/ml), caspofungin (MIC 1 ug/ml), micafungin (MIC <0.015 ug/ml), itraconazole (MIC 1 ug/ml), and posaconazole (MIC 0.5 ug/ml). Patient was maintained on topical amphotericin B, prednisolone acetate, and cyclopentolate hydrochloride and oral posaconazole. Three months after initial trauma, there was no evidence of recurrent infection.

Conclusion: N. udagawae is a rare species causing fungal keratitis, with only one prior published case in the literature. Distinguishing N. udagawae from the more common A. fumigatus is important given their different susceptibilities to antifungal agents. Most isolates of A. fumigatus are susceptible to amphotericin B, extended-spectrum triazoles, and caspofungin, while N. udagawae tends to demonstrate more in vitro resistance to many agents. This case highlights the importance of definite identification and sensitivities for fungal isolates, as misclassification based on initial morphology can affect clinical responsiveness and outcomes.

Disclosure: N

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