Ocular Microbiology and Immunology Group
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2017 OMIG Abstract 21

Scopulariopsis brevicaulis fungal keratitis
Norberto Mancera MD¹, Hershel Patel MD¹, Bradley Fouraker MD^1,2
University of South Florida Mosani College of Medicine, Tampa, Florida

Purpose: To present a case and review of fungal keratitis secondary to Scopulariopsis brevicaulis.

Methods: literature review was performed by searching the keyword “Scopulariopsis brevicaulis” and “keratitis”. Additionally, the medical records of a patient with S. brevicaulis infection were reviewed retrospectively.

Results: A 67-year-old contact lens wearing white male reported getting scratched on his right eye 3.5 weeks before. He was seen at urgent care who prescribed gentamycin QID. A week later he was seen by a community ophthalmologist who diagnosed him with a corneal ulcer and started him on fortified vancomycin, fortified gentamycin, and oral acyclovir. The patient was subsequently referred to our hospital for evaluation by the cornea service due to concerns of progression.

Visual acuity OD was 20/100 on presentation, with normal intraocular pressure. Exam revealed 2+ injection with ciliary flush and a paracentral 5.5mm x 5.0mm area of stromal haze with a 5.5mm x4.5mm epithelial defect. The anterior chamber had 1+ cell and flare. Structures posterior to the iris were indiscernible at the time due to the corneal defect. The patient was admitted for close management and was started on fortified vancomycin and tobramycin hourly.

By the second day of hospitalization visual acuity had further declined, therefore treatment was advanced to include hourly natamycin drops, due to the high concern of fungal infection. On the fifth day of inpatient status corneal cultures had come back positive for nine colonies of S. brevicaulis. Due to the nature of this highly pathogenic organism an infectious disease consult was placed and the patient was started on oral voriconazole.

Conclusion: S. brevicaulis is a rare and highly pathogenic organism that is usually unresponsive to treatment with topical anti-fungal agents. Most reports in the literature indicate the need for early peripheral keratoplasty to remove the infected tissue. We demonstrate successful treatment with medical management.

2017 Agenda and Abstracts | < Previous Next >