PMC3848927_01
Previous treatment with corticosteroids.. Abbreviations: BM, betamethasone; FM, fluorometholone; PSL, prednisolone; HSK1, herpes simplex keratitis (geographic ulcer and stromal keratitis); TLO, trabeculotomy; TLE, trabeculectomy; HSK2, herpes simplex keratitis (stromal keratitis); PKP, penetrating keratoplasty; CI, corneal infiltration of unknown cause; FK, fungal keratitis.
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His ocular history in the right eye included cataract surgery (1990), five episodes of herpes simplex keratitis (2006, 2007, 2008 [two times], and 2010), three glaucoma surgeries (2007 [two times] and 2008), and bullous keratopathy (2011). He had been treated with corticosteroids for years (Figure 1).
Slit-lamp and light microscopy photographs.. Notes: (A) Oval infiltrate with irregular margins in the temporal half of the cornea at initial presentation. (B) Light microscopy of corneal scrapings taken from the right eye at initial presentation revealed uniformly thick septate hyphae. (C) There was a foreign body in the central infiltrate after corneal debridement (arrow). (D) Light microscopy that revealed conidia with three apical appendages (yellow arrows) and a single basal appendage (white arrow) (lactophenol cotton blue staining; x400). (E) Microscopic findings of conidia produced on potato dextrose agar 1 month after incubation (lactophenol cotton blue staining; x400). (F) Relapse of the fungal keratitis, 8 months after discharge (arrows).
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Slit-lamp examination of the right eye revealed conjunctival injection and an oval infiltrate with feathery margins in the temporal half of the cornea (Figure 2A). Light microscopy of corneal scrapings taken from the right eye at initial presentation revealed uniformly thick septate hyphae (Figure 2B). A foreign body was found in the infiltrate when corneal debridement was performed (Figure 2C). The isolate was suspected to be Pestalotiopsis spp., based upon light microscopy with lactophenol cotton blue staining, which revealed conidia-bearing appendages (Figure 2D). A colony incubated on PDA at 27 C in the dark for one month revealed that the conidia were narrowly fusoid to fusoid-clavate, straight or somewhat curved, five-celled, with the upper cell conical to cylindrical, hyaline, fairly thin-walled, without visible cellular contents, and bearing two to four rather stout central apical appendages, 10-20 mum long and up to 1 mum wide (Figure 2E). Four days later, the keratitis had relapsed (Figure 2F).