Ocular Microbiology and Immunology Group
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2026 OMIG Abstract

POSTER PRESENTATION


Trouble From the Garden: A Case of Prototheca Wickerhamii Keratitis

Jennifer Chung¹, Angela Chang^1,2, and Matthew Santos¹

¹Scheie Eye Institute, Philadelphia, Pennsylvania; ²University of Illinois Chicago, Department of Ophthalmology, Chicago, Illinois

Purpose: To describe a case of perforated neurotrophic ulcer treated with penetrating keratoplasty whose post-operative course was complicated by Prototheca wickerhamii keratitis, subsequently managed with therapeutic penetrating keratoplasty.

Methods: Relevant case data and images were collected via retrospective chart review.

Results: A 70-year-old male with history of neurotrophic ulcer OS presents with corneal perforation and undergoes penetrating keratoplasty and lateral tarsorrhaphy. The first two weeks of his post-operative course are uncomplicated, after which he is lost to follow-up. He re-presents at post-operative week 10 with a new temporal corneal ulcer OS. Cultures were collected, and topical fortified tobramycin and vancomycin are initiated. The exam continues to worsen over the following 8 weeks, at which point the culture results with undifferentiated yeast. Topical amphotericin and oral fluconazole were added. Soon after, the culture is further differentiated to identify the algae Prototheca wickerhamii. A therapeutic penetrating keratoplasty was then performed without signs of recurrent infection within the first post-operative month. The patient unfortunately passed away prior to further follow-up.

Conclusions: Keratitis secondary to algae infection is rare but should be considered in cases of recalcitrant keratitis, particularly in patients with prior ocular surgery, trauma, or immunosuppression. Medical therapy for Prototheca keratitis is typically insufficient and requires surgical removal for definitive management.