J Korean Ophthalmol Soc.  2021 Jan;62(1):114-119. 10.3341/jkos.2021.62.1.114.

Pseudallescheria boydii Necrotizing Scleritis Treated with Several Antifungal Agents

• Lee SH
• Kim JT
• Lee MK
• Jeong JH
• Kim KW

• KMID: 2511533
• DOI: http://doi.org/10.3341/jkos.2021.62.1.114

Abstract

Purpose
We report a case of post-pterygium excisional Pseudallescheria boydii (P. boydii) necrotizing scleritis successfully treated with multi-antifungal agents.
Case summary
A 73-year-old female with a history of pterygium excision 6 years prior was referred to our institute because of worsening scleritis in the left eye during high-dose, 2-week steroid treatment. On the initial visit, an oval ulcer was observed in the temporal sclera adjacent to the limbus. All steroids were stopped and 1% voriconazole, 5% natamycin, 2.5% vancomycin, and 5% ceftazidime eyedrops were applied every hour and oral voriconazole 200 mg prescribed once a day, but the scleral necrosis continued to worsen. On day 10, the filamentous fungus P. boydii was isolated; 0.5% caspofungin eyedrops were added and the topical voriconazole concentration increased to 2%. Six weeks later, despite epithelization over the scleral necrosis, choroidal detachment developed. The antifungal treatment was continued and a dispersive, ophthalmic viscosurgical device inserted in the anterior chamber. At 14 weeks of treatment, the scleral necrosis was completely epithelialized and the choroidal detachment had disappeared.
Conclusions
When encountering a case of P. boydii-caused necrotizing scleritis developing after pterygium excision surgery, long-term intensive treatment with several antifungal agents must be considered.

Keyword

Caspofungi, Fungal scleritis, Pseudallescheria boydii, Pterygium, Voriconazole