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Post-traumatic Fungal Keratitis Caused by Carpoligna sp.

Chew, Hall F MD, FRCS(C); Jungkind, Donald L PhD; Mah, Dean Y MD, FRCS(C); Raber, Irving M MD, FRCS(C); Toll, Adam D MD; Tokarczyk, Mindy J; Cohen, Elisabeth J MD

doi: 10.1097/ICO.0b013e3181af3954
Case Report

Purpose: To report the first case of fungal keratitis caused by presumed Carpoligna species.

Methods: A 37-year-old gardener sustained a full-thickness, stellate corneal laceration while cutting wood outdoors with a circular saw. Two months after surgical repair, he developed a severe infectious keratitis with descemetocoele at the apex of the original stellate laceration.

Results: Culture results confirmed fungal elements without evidence of bacteria. Oral and topical voriconazole were initiated. Due to compliance and cost issues, voriconazole was replaced with natamycin 5% prior to discharge from hospital. The patient improved and healed without perforation. The patient was left with a central stromal scar. DNA extraction from the fungal colony allowed PCR amplification of the 28s ribosomal RNA region of the fungus that led to the diagnosis of Carpoligna pleurothecii. Corticosteroids were never used during the patient's treatment.

Conclusion: This is the first reported case of infectious keratitis caused by presumed Carpoligna species. The treatment for Carpoligna pleurothecii keratitis includes voriconazole, natamycin, and possibly amphotericin B.

From the *Cornea Service, Wills Eye Institute, Thomas Jefferson University, Philadelphia, PA; †Sunnybrook Health Sciences Centre, Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada; ‡Department of Microbiology; §Department of Pathology, Anatomy, and Cell Biology, Jefferson Medical College, Thomas Jefferson University, Philadelphia, PA; and ¶Department of Ophthalmology, University of Alberta, Edmonton, Alberta, Canada.

Received for publication January 17, 2009; revision received April 15, 2009; accepted May 16, 2009.

Reprints: Hall F. Chew, MD, University of Toronto, Sunnybrook Health Sciences Centre, Department of Ophthalmology-Suite M1-302B, 2075 Bayview Ave., Toronto, Ontario, M4 N 3M5, Canada (e-mail: hall.chew@utoronto.ca).

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