PMC3468285_01
Slit-lamp photographs. (A) Oval infiltrate with irregular margins in the nasal half of the cornea at initial presentation. (B) Fluorescein staining at initial presentation. The lesion was not stained with fluorescein. (C) One week after admission, the infiltrate improved, but in the central part was still deep. (D) A stromal scar remained 3 months after the patient was discharged.
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Slit-lamp examination of the right eye revealed conjunctival injection, an oval infiltrate with irregular margins in the nasal half of the cornea, 2+ cells, keratic precipitates, and hypopyon in the anterior chamber (Figure 1A and B). One week later, the infiltrate improved, but the central part of the infiltrate was still deep (Figure 1C). A stromal scar persisted for 3 months after discharge, and visual acuity was 0.02 (Figure 1D).
Treatment course for the right eye.. Abbreviations: MCZ, miconazole; FLCZ, fluconazole; VCZ, voriconazole; PMR, pimaricin; ITZ, itraconazole.
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The treatment course in the right eye is shown in Figure 2.
Morphological findings of the isolate. (A) Colony incubated on potato dextrose agar at 25 C for 13 days. (B, C, D) Microscopic findings on slide cultures grown on potato dextrose agar. Phialides arise from conidiophore apices or hyphae as side branches. They are straight or twisted (asterisks), tapering toward the tops, with an open end and collarette (arrows). Phialoconidia are cylindrical with pointed ends, or narrow spindle-shaped, straight, or slightly curved, and mostly uniseptate. Lactophenol cotton blue stain. (B) x400; (C and D), and inset x600.
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The fungus produced dull salmon-pink, flat and smooth colonies, with fine aerial hyphae at the marginal area, after culture on potato dextrose agar at 25 C in the dark for 13 days (Figure 3A). Slide culture preparations showed conidiophores that were hyaline and hypha-like, unbranched or branched, and forming a scanty cluster (Figure 3B). These were hyaline, hypha-like, and tapered toward the tops, with an open end and collarette (Figure 3B and C, arrows). Phialides were straight or occasionally twisted (Figure 3B and D, asterisks).