A rare case of scleral buckle infection with Curvularia species
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Scleral buckling is an established modality of treating retinal detachment. Being an external implant the buckle may be prone to infections. We report such a case with a delayed presentation and a rare etiology.
A 45 year old male presented with redness, foreign body sensation and discharge for one month in his right eye. The patient had undergone a retinal detachment surgery elsewhere 14 years back without any visual gain. Right eye demonstrated no perception of light and the best corrected visual acuity in the left eye was 6/6, N6. On downgaze an exposed and anteriorly displaced scleral buckle was identified with black deposits and mucopurulent material overlying the buckle. Scleral buckle removal was done. On microbiological examination Curvularia species was identified. Successful treatment with antifungals was done.
Scleral buckle infection with dematiaceous fungi is a rare occurrence. To the best of our knowledge this is the first case report describing a buckle infection caused by the curvularia species.
KeywordsBuckle infection Dematiaceous fungus
Scleral buckling has been an established and effective surgical method for treating retinal detachments since over 60 years . In the recent years pars plana vitrectomy has become more popular, however, scleral buckling has several indications as the primary procedure of choice in a rhegmatogenous retinal detachment. Being an external implant the scleral buckle is prone to get infected and the infection may set in even years after the primary procedure. The commonest organisms reportedly causing a scleral buckle infection are gram positive cocci [2, 3, 4], however, in rare cases a fungal infection may set in especially in an immunocompromised host. We report a case of buckle infection due to Curvularia species in an immunocompetent patient. To the best of our knowledge this is the first report of a case describing buckle infection due to Curvularia species.
The most commonly isolated organism has been reported to be coagulase negative staphylococcus, mainly Staphylococcus epidermidis [2, 4, 7]. However, there have also been reports of buckle infections caused my atypical mycobacteria, corynebacteria and fungi . Immunocompromised hosts are particularly susceptible to fungal infections and the commonest fungus causing a buckle infection is reported to be Aspergillus species [4, 7, 8].
Dematiaceous fungi are ubiquitous in nature and are common saprophytes on plant material and in soil, developing dark colonies. In the eye they most frequently cause a corneal infection. Some of the dematiaceous fungi known to cause ocular infection are Alternaria, Curvularia, Bipolaris, Exserohilum and Coelomycetes species .
It is extremely rare to find a buckle infection caused by a dematiaceous fungus. Bakri et al. have reported a buckle infection caused by the dematiaceous fungus Alternaria species .
In our case, a young healthy male developed a dematiaceous fungal infection with Curvularia species and presented with the infection 14 years after the scleral buckle procedure. Buckle infections may present years after the primary procedure and it is important for clinicians to be aware of such delayed presentations which may occur even in immunocompetent individuals.
To the best of our knowledge this is the first case report describing the morphological and microbiological findings in a buckle infection caused by Curvularia species. This case highlights the importance of a strong suspicion of fungal etiology based on the clinical presentation and the need for urgent management. Clinicians need to be aware of this entity and not disregard its possibility in an immunocompetent individual.
Availability of data and materials
All data generated and analyzed during this study are included in this article.
SS managed the patient medically and surgically, AS drafted the manuscript and reviewed the literature, MA provided expert advice regarding management of the patient, AG undertook the microbiological examination, RM and LP reviewed the literature and helped in interpreting the data. All authors reviewed the manuscript. All authors read and approved the final manuscript.
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No ethical approval required.
Consent for publication
Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor of this journal.
The authors declare that they have no competing interests.
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