Advertisement

International Ophthalmology

, Volume 38, Issue 5, pp 2211–2217 | Cite as

Interface Scopulariopsis gracilis fungal keratitis following Descemet’s stripping automated endothelial keratoplasty (DSAEK) with a contaminated graft

  • Craig Wilde
  • Marco Messina
  • Tara Moshiri
  • Susan E. Snape
  • Senthil Maharajan
Case Report

Abstract

Purpose

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.

Methods

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.

Results

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.

Conclusion

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.

Keywords

Scopulariopsis gracilis Fungal keratitis DSAEK Infected corneal graft Descemet’s stripping automated endothelial keratoplasty 

Notes

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

Informed consent was obtained from all individual participants included in the study.

References

  1. 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
  2. 2.
    Cuenca-Estrella M, Gomez-Lopez A, Mellado E, Buitrago MJ, Monzo´n A, Rodriguez-Tudela JL (2003) Scopulariopsis brevicaulis, a fungal pathogen resistant to broad-spectrum antifungal agents. Antimicrob Agents Chemother 47(7):2339–2341CrossRefPubMedCentralGoogle Scholar
  3. 3.
    Tosti A, Piraccini BM, Lorenzi S (2000) Onychomycosis caused by nondermatophytic molds: clinical features and response to treatment of 59 cases. J Am Acad Dermatol 42(2 Pt 1):217–224CrossRefGoogle Scholar
  4. 4.
    Tosti A, Piraccini BM, Stinchi C, Lorenzi S (1996) Onychomycosis due to Scopulariopsis brevicaulis: clinical features and response to systemic antifungals. Br J Dermatol 135(5):799–802CrossRefPubMedCentralGoogle Scholar
  5. 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
  6. 6.
    Endo S, Hironaka M, Murayama F, Yamaguchi T, Sohara Y, Saito K (2002) Scopulariopsis fungus ball. Ann Thorac Surg 74(3):926–927CrossRefPubMedCentralGoogle Scholar
  7. 7.
    Dhar J, Carey PB (1993) Scopulariopsis brevicaulis skin lesions in an AIDS patient. AIDS 7(9):1283–1284CrossRefPubMedCentralGoogle Scholar
  8. 8.
    Ragge NK, Dean Hart JC, Easty DL, Tyers AG (1990) A case of fungal keratitis caused by Scopulariopsis brevicaulis: treatment with antifungal agents and penetrating keratoplasty. Br J Ophthalmol 74(9):561–562CrossRefPubMedCentralGoogle Scholar
  9. 9.
    Kouyoumdjian GA, Forstot SL, Durairaj VD, Damiano RE (2001) Infectious keratitis after laser refractive surgery. Ophthalmology 108(7):1266–1268CrossRefPubMedCentralGoogle Scholar
  10. 10.
    Lotery AJ, Kerr JR, Page BA (1994) Fungal keratitis caused by Scopulariopsis brevicaulis: successful treatment with topical amphotericin B and chloramphenicol without the need for surgical debridement. Br J Ophthalmol 78(9):730CrossRefPubMedCentralGoogle Scholar
  11. 11.
    Del Prete A, Sepe G, Ferrante M, Loffredo C, Masciello M, Sebastiani A (1994) Fungal keratitis due to Scopulariopsis brevicaulis in an eye previously suffering from herpetic keratitis. Ophthalmologica 208(6):333–335CrossRefPubMedCentralGoogle Scholar
  12. 12.
    Mondal KK, Chattopadhyay C, Ray B, Das D, Biswas S, Banerjee P (2012) Corneal ulcer with Scopulariopsis brevicaulis and Staphylococcus aureus–a rare case report. J Indian Med Assoc 110(4):253–254PubMedPubMedCentralGoogle Scholar
  13. 13.
    Armitage WJ (2011) Preservation of human cornea. Transfus Med Hemother 38(2):143–147CrossRefPubMedCentralGoogle Scholar
  14. 14.
    Polack FM, Locatcher-Khorazo D, Gutierrez E (1967) Bacteriologic study of “donor” eyes. Evaluation of antibacterial treatments prior to corneal grafting. Arch Ophthalmol 78(2):219–225CrossRefPubMedCentralGoogle Scholar
  15. 15.
    Armitage WJ, Easty DL (1997) Factors influencing the suitability of organ-cultured corneas for transplantation. Invest Ophthalmol Vis Sci 38(1):16–24PubMedPubMedCentralGoogle Scholar
  16. 16.
    Malecha MA (2004) Fungal keratitis caused by Scopulariopsis brevicaulis treated successfully with natamycin. Cornea 23(2):201–203CrossRefPubMedCentralGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2017

Authors and Affiliations

  1. 1.Ophthalmology and Vision Sciences, Division of Clinical Neurosciences, B Floor, EENT CentreQueen’s Medical Centre, University of NottinghamNottinghamUK
  2. 2.Microbiology departmentQueen’s Medical CentreNottinghamUK
  3. 3.Ophthalmology departmentQueen’s Medical CentreNottinghamUK

Personalised recommendations