Exophiala dermatitidis Endophthalmitis: Case Report and Literature Review
We report a case of a 59-year-old male patient with a postoperative fungal infection of the left eye. A dark-pigmented yeast, Exophiala dermatitidis (previously known as Wangiella dermatitidis), was identified from the culture of the biopsy taken from the posterior capsule. The infection was successfully eradicated by a combination of surgical and medical (i.e., voriconazole and fluconazole) treatment. This is the first report of successfully treated E. dermatitidis endophthalmitis, which demonstrates that a prompt and aggressive antifungal therapy combined with surgical intervention is necessary to prevent vision loss in cases of endophthalmitis due to Exophiala species. Beside the case description, we also aim to provide a literature review of previously reported eye infections caused by Exophiala species in order to help the future diagnosis and management of the disease.
KeywordsDematiaceous fungi Exophiala Keratitis Endophthalmitis Antifungal susceptibility
This study was supported by the “Lendület” Grant of the Hungarian Academy of Sciences (LP2016-8/2016) and the Project GINOP-2.3.2-15-2016-00035 (Széchenyi 2020 Programme). LG is supported by the Postdoctoral Excellence Programme (PD 120808) of the Hungarian National Research, Development and Innovation Office (NKFI Office). PM would like to thank Deanship of Scientific Research at Majmaah University, Kingdom of Saudi Arabia, for supporting this work under Project No. 37/106.
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Conflict of interest
The authors declare that they have no conflict of interest.
This article does not contain any studies with animals performed by any of the authors.
For this type of study formal consent is not required.
- 5.Chowdhary A, Meis JF, Guarro J, de Hoog GS, Kathuria S, Arendrup MC, Arikan-Akdagli S, Akova M, Boekhout T, Caira M, Guinea J, Chakrabarti A, Dannaoui E, van Diepeningen A, Freiberger T, Groll AH, Hope WW, Johnson E, Lackner M, Lagrou K, Lanternier F, Lass-Flörl C, Lortholary O, Meletiadis J, Muñoz P, Pagano L, Petrikkos G, Richardson MD, Roilides E, Skiada A, Tortorano AM, Ullmann AJ, Verweij PE, Cornely OA, Cuenca-Estrella M, European Society of Clinical Microbiology and Infectious Diseases Fungal Infection Study Group.; European Confederation of Medical Mycology. ESCMID and ECMM joint clinical guidelines for the diagnosis and management of systemic phaeohyphomycosis: diseases caused by black fungi. Clin Microbiol Infect. 2014;20:47–75.CrossRefPubMedGoogle Scholar
- 19.White TJ, Burns S, Lee S, Taylor J. Amplification and direct sequencing of fungal ribosomal RNA genes for phylogenetics. In: Innis MA, Gelfand DH, Sninsky JJ, White TJ, editors. PCR protocols: a guide to methods and applications. New York: Academic Press Inc; 1990. p. 315–22.Google Scholar
- 21.Hall TA. BioEdit: a user-friendly biological sequence alignment editor and analysis program for Windows 95/98/NT. Nucleic Acids Symp Ser. 1999;41:95–8.Google Scholar
- 23.Clinical and Laboratory Standards Institute. Reference method for broth dilution antifungal susceptibility testing of filamentous fungi. In: Approved standard CLSI document M38-A2. Wayne: CLSI; 2008.Google Scholar
- 24.Manikandan P, Varga J, Kocsubé S, Anita R, Revathi R, Németh TM, Narendran V, Vágvölgyi C, Panneer Selvam K, Shobana CS, Babu Singh YR, Kredics L. Epidemiology of Aspergillus keratitis at a tertiary care eye hospital in South India and antifungal susceptibilities of the causative agents. Mycoses. 2013;56:26–33.CrossRefPubMedGoogle Scholar
- 25.Krizsán K, Tóth E, Nagy LG, Galgóczy L, Manikandan P, Chandrasekaran M, Kadaikunnan S, Alharbi NS, Vágvölgyi C, Papp T. Molecular identification and antifungal susceptibility of Curvularia australiensis, C. hawaiiensis and C. spicifera isolated from human eye infections. Mycoses. 2015;58:603–9.CrossRefPubMedGoogle Scholar
- 26.Homa M, Shobana CS, Singh YR, Manikandan P, Selvam KP, Kredics L, Narendran V, Vágvölgyi C, Galgóczy L. Fusarium keratitis in South India: causative agents, their antifungal susceptibilities and a rapid identification method for the Fusarium solani species complex. Mycoses. 2013;56:501–11.CrossRefPubMedGoogle Scholar
- 27.Hassan AS, Al-Hatmi AM, Shobana CS, van Diepeningen AD, Kredics L, Vágvölgyi C, Homa M, Meis JF, de Hoog GS, Narendran V, Manikandan P, IHFK Working Group. Antifungal susceptibility and phylogeny of opportunistic members of the genus Fusarium causing human keratomycosis in South India. Med Mycol. 2016;54:287–94.CrossRefPubMedGoogle Scholar