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PHOTO ESSAY
Year : 2021  |  Volume : 1  |  Issue : 4  |  Page : 806-807

Unusual keratitis caused by Penicillium marneffei in an immunocompetent patient


PBMA's H.V. Desai Eye Hospital, Pune, Maharashtra, India

Date of Submission21-Aug-2020
Date of Acceptance29-Mar-2021
Date of Web Publication09-Oct-2021

Correspondence Address:
Dr. Reshma Vijay Bandekar
H.V. Desai Eye Hospital, Pune - 411 060, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_2690_20

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  Abstract 


Keywords: Corneal ulcer, fungal keratitis, Penicillium marneffei, therapeutic keratoplasty


How to cite this article:
Joshi HM, Bandekar RV, Joshi SA, Kher S, Deshpande M. Unusual keratitis caused by Penicillium marneffei in an immunocompetent patient. Indian J Ophthalmol Case Rep 2021;1:806-7

How to cite this URL:
Joshi HM, Bandekar RV, Joshi SA, Kher S, Deshpande M. Unusual keratitis caused by Penicillium marneffei in an immunocompetent patient. Indian J Ophthalmol Case Rep [serial online] 2021 [cited 2021 Oct 26];1:806-7. Available from: https://www.ijoreports.in/text.asp?2021/1/4/806/327653



A 65 years old man presented with complaints of pain, redness, and diminution of vision in the left eye for the past 1 month following trauma with vegetative matter. The best-corrected visual acuity (BCVA) of the left eye was counting fingers close to the face. Slit-lamp examination revealed a 7*6 mm corneal abscess with central perforation with iris incarceration and pseudocornea formation, surrounded by stromal infiltrates [Figure 1]a.
Figure 1: (a) Slit-lamp photograph of anterior segment shows a 7*6 mm corneal abscess with central perforation, iris incarceration, and pseudocornea formation, surrounded by stromal infiltrates and endoexudates. (b) One-year post-therapeutic penetrating keratoplasty, BCVA recorded was 20/80

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On investigation, the patient had no systemic illness and was seronegative. A clinical diagnosis of perforated fungal keratitis was made. Therapeutic keratoplasty was performed using a Cornisol—preserved donor cornea.

After surgery, the patient received a combination of topical (5% natamycin, 1% voriconazole 1 hourly) and oral antifungal (Tab Ketoconazole 200 mg BD) therapy for 6 weeks.

Host corneal button culture on Sabouraud's dextrose agar (SDA) revealed white-colored growth which later turned wooly yellowish-green, progressing to dark green color with rapidly diffusing dark red pigment. Slide mounted with Lactophenol cotton blue demonstrated brush-like conidial heads [Figure 2].
Figure 2: Slide mounted in lactophenol cotton blue demonstrated brush-like conidial heads

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The sample was also cultured on Brain Heart Infusion Agar (BHIA) showing the mold-to-yeast conversion, which is diagnostic of P. marneffei.

At 1-year follow-up [Figure 1]b, the cornea was clear and BCVA was 20/80.


  Discussion Top


P. marneffei keratitis is an opportunistic infection, associated with immunocompromised states, especially with acquired immunodeficiency syndrome (AIDS).[1]

There are very few cases of Penicillium keratitis reported in the literature [Table 1]. No information is available on differences in P. marneffei induced keratitis in an immunocompetent or immunocompromised host. Vyawahare et al. reported P. marneffei keratitis, with punched-out margins and no satellite lesions, in an immunocompetent farmer. He was treated with amphotericin B 0.15% and natamycin 5% topically.[2] In a case reported by Arora et al. of a 12-year-old patient, diagnosed as shield ulcer, Penicillium was isolated from the infiltrate, which was deep stromal.[3]
Table 1: Enumerating all previous reports on penicillium keratitis

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Our patient presented with a corneal abscess and perforation. He underwent therapeutic penetrating keratoplasty and is doing well. Although P. marneffei keratitis is rare in immunocompetent individuals, we emphasize the need for complete microbiological evaluation for proper diagnosis and appropriate treatment.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Wong SY, Wong KF. Penicillium marneffei Infection in AIDS. Patholog Res Int 2011;2011:764293.  Back to cited text no. 1
    
2.
Vyawahare CR, Misra RN, Gandham NR, Angadi KM, Paul R. Pencillium keratitis in an Immunocompetent Patient from Pune, Maharashtra, India. J Clin Diagn Res 2014;8:DD01-2.  Back to cited text no. 2
    
3.
Arora R, Gupta S, Raina UK, Mehta DK, Taneja M. Penicillium keratitis in vernal Keratoconjunctivitis. Indian J Ophthalmol Case Rep2002;50:215-6.  Back to cited text no. 3
    


    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1]



 

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