Interface Scopulariopsis gracilis fungal keratitis following Descemet’s stripping automated endothelial keratoplasty (DSAEK) with a contaminated graft
To report for the first time a case of interface Scopulariopsis gracilis fungal keratitis following Descemet’s stripping automated endothelial keratoplasty (DSAEK) with a contaminated graft.
A 57-year-old man with bilateral keratoconus and previous bilateral penetrating keratoplasties (PK) developed graft failure in association with marked corneal ectasia. He underwent a successful DSAEK. Unfortunately, a contaminated graft was transplanted and the following morning we were contacted by the eye bank to inform us a slow-growing fungus had been detected in the culture plates inoculated with dextran solution used to store the issued corneoscleral button. Immediate patient review revealed four infiltrates in the interface between the donor and the recipient tissue. The patient returned to theatre for the removal of the infected graft and was successfully treated with topical amphotericin 0.15%, voriconazole 1% and oral voriconazole and later oral itraconazole. Two intracameral injections of 5 µg in 0.1 ml of amphotericin B were also performed.
A reference laboratory cultured and identified the fungus as Scopulariopsis gracilis species. The patient responded to treatment and eventually achieved a spectacle-corrected logMAR visual acuity of 0.3 following a delayed PK.
Scopulariopsis gracilis fungal keratitis is a rare infection, and the species can be difficult to eradicate. This is the first case report of an infection secondary to a contaminated graft with the species, and we report its successful treatment with an excellent visual outcome.
KeywordsScopulariopsis gracilis Fungal keratitis DSAEK Infected corneal graft Descemet’s stripping automated endothelial keratoplasty
Compliance with ethical standards
Conflicts of interest
The authors declare that they have no conflicts of interest. The authors alone are responsible for the content and writing of the paper.
Informed consent was obtained from all individual participants included in the study.
- 1.Sandoval-Denis M, Sutton DA, Fothergill AW, Cano-Lira J, Gené J, Decock CA, de Hoog GS, Guarroa J (2013) Scopulariopsis, a poorly known opportunistic fungus: spectrum of species in clinical samples and in vitro responses to antifungal drugs. J Clin Microbiol 51(12):3937–3943CrossRefPubMedCentralGoogle Scholar
- 5.Salmon A, Debourgogne A, Vasbien M, Cle´ment L, Collomb J, Ple´nat F, Bordigoni P, Machouart M (2010) Disseminated Scopulariopsis brevicaulis infection in an allogeneic stem cell recipient: case report and review of the literature. Clin Microbiol Infect 16(5):508–512CrossRefPubMedCentralGoogle Scholar