J Korean Ophthalmol Soc.  2010 Jan;51(1):136-140.

A Case of Candida Parapsilosis Keratitis With Atypical Presentation

• Kim HD
• Kim SY
• Jung MS

Abstract

PURPOSE
To report a case of Candida parapsilosis keratitis with atypical presentation demonstrated by subepithelial white dot deposits without peripheral inflammatory reaction.
CASE SUMMARY
A 45-year-old woman with Stevens-Johnson syndrome had used topical corticosteroid and bandage contact lens due to recurrent epithelial defect and keratitis. Multiple subepithelial white dot deposits were revealed on the central corneal area without surrounding inflammation. The corneal lesion was improved after epithelial debridement with topical antibiotics and steroid eyedrops. A few months later, however, the corneal lesion recurred. Smear cytology was performed, and yeast-formed fungi and pseudohyphae were found. C. parapsilosis was identified in the culture study. Therefore, the topical steroid was withdrawn and 0.15% topical Amphotericin was applied. The corneal lesion improved and corneal opacity did not progress.
CONCLUSIONS
The case reported in this study is C. parapsilosis keratitis with multiple subepithelial white dot deposits without typical presentations of fungal kertitis. Although no typical infectious indication was evident, infection should be suspected in patients who show abnormal corneal lesion under immunosuppressive treatment.

Keyword

Candida parapsilosis; Keratitis; Subepithelial deposit

MeSH Terms

Amphotericin B
Anti-Bacterial Agents
Bandages
Candida
Corneal Opacity
Debridement
Female
Fungi
Humans
Inflammation
Keratitis
Middle Aged
Ophthalmic Solutions
Stevens-Johnson Syndrome
Amphotericin B
Anti-Bacterial Agents
Ophthalmic Solutions

Figure

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  Figure 1. Anterior segment photograph of both eyes at initial presentation. Multiple white dot deposits on left corneal surface without corneal edema and stromal infiltration (A). Multiple corneal epithelial defects on the right corneal surface (B).

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  Figure 2. Smear cytology with Papanicolaou stain (×800). Yeast-formed organisms (A) and pseudohyphae-like structures (B) are seen.

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  Figure 3. Characteristics of C. parapsilosis. A. Small white colonies on 5% blood agar plate. B. Microscopic findings of colonies with Gram stain.

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  Figure 4. Photographs of the right (A) and left (B) eyes after treatment. There are corneal opacities and stromal thinning without epithelial defect after 0.15% Amphotericin B treatment.

Reference

References

1. Hahn YH, Hahn TW, Tchah HW, et al. Epidemiology of Infectious Keratitis (II): A Multicenter Study. J Korean Ophthalmol Soc. 2001; 42:247–65.

2. Sun RL, Jones DB, Wilhelmus KR. Clinical Characteristics and Outcome of Candida Keratitis. Am J Ophthalmol. 2007; 143:1043–5.

3. Bourcier T, Touzeau O, Thomas F, et al. Candida Parapsilosis aberrations. Cornea. 2003; 22:51–5.

4. Muallem MS, Alfonso EC, Romano AC, et al. Bilateral Candida Parapsilosis Interface Keratitis after In Situ Keratomileusis. J Cataract Refract Surg. 2003; 29:2002–5.

5. Weems JJ. Candida Parapsilosis: Epidemiology, Pathogenicity, Clinical Manifestations, and Antimicrobial Susceptibility. Clin Infect Dis. 1992; 14:756–66.

6. Solomon R, Biser SA, Donnenfeld ED, et al. Candida Parapsilosis Keratitis Following Treatment of Epithelial Ingrowth After Laser In Situ Keratomileusis. Eye Contact Lens. 2004; 30:85–6.

7. Fekrat S, Haller JA, Green WR, et al. Pseudophakic Candida aberrations Endophthalmitis with Consecutive Keratitis. Cornea. 1995; 14:212–6.