Korean J Ophthalmol.  2012 Dec;26(6):465-468. 10.3341/kjo.2012.26.6.465.

Phialemonium obovatum Keratitis after Penetration Injury of the Cornea

• Hong KH
• Ryoo NH
• Chang SD

• KMID: 1499687
• DOI: http://doi.org/10.3341/kjo.2012.26.6.465

Abstract

Phialemonium keratitis is a very rare case and we encountered a case of keratitis caused by Phialemonium obovatum (P. obovatum) after penetrating injury to the cornea. This is the first case report in the existing literature. A 54-year-old male was referred to us after a penetration injury, and prompt primary closure was performed. Two weeks after surgery, an epithelial defect and stromal melting were observed near the laceration site. P. obovatum was identified, and then identified again on repeated cultures. Subsequently, Natacin was administered every two hours. Amniotic membrane transplantation was performed due to a persistent epithelial defect and impending corneal perforation. Three weeks after amniotic membrane transplantation, the epithelial defect had completely healed, but the cornea had turned opaque. Six months after amniotic membrane transplantation, visual acuity was light perception only, and corneal thinning and diffuse corneal opacification remained opaque. Six months after amniotic membrane transplantation, visual acuity was light perception only, and corneal thinning and diffuse corneal opacification remained.

Keyword

Corneal ulcer; Fungi; Phialemonium obovatum

MeSH Terms

Cornea/*injuries/microbiology/pathology
Diagnosis, Differential
Eye Infections, Fungal/diagnosis/etiology/*microbiology
Eye Injuries, Penetrating/*complications/diagnosis
Follow-Up Studies
Fungi/isolation & purification
Humans
Keratitis/diagnosis/etiology/*microbiology
Male
Middle Aged

Figure

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  Fig. 1 Slit lamp photograph of the first day after operation showing a clear suture wound with blood coagulum in the anterior chamber and slightly displaced and swollen lens.

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  Fig. 2 Bluelight slit lamp photograph with fluorescein dye stain 2 weeks after primary suture of the lacerated cornea showed a large size epithelial defect and ring-shaped diffuse subepithelial and stromal inflammatory cell infiltration with stromal melting.

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  Fig. 3 Direct inoculation of the corneal scrapping specimen showed a broadly spreading grayish color and slightly fuzzy colonies with dark centers after 7 days of incubation at 25℃ on a blood agar plate.

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  Fig. 4 Microscopic findings of Phialemonium obovatum (latophenol cotton blue stain, ×1,000). Septated and hyaline hyphae and oval to tear-shaped conidia are observed. Conidia are single-celled and appear slightly cut off at the base. Phialides form singly along the hyphae with no septum.

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  Fig. 5 At 5 months postoperatively, bluelight slit lamp photograph showed a completely opaque cornea.

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