A rare case of Arthrographis kalrae keratomycosis in a non-contact lens wearer

Abstract


 Purpose: Keratomycoses secondary to Arthrographis kalrae are rarely reported. Previous cases involved patients with contact lens wear. Herein we report a rare case of severe fungal keratitis due to Arthrographis kalrae in a non-contact lens wearer.Methods: Case report.Results: A 52-year-old male presented with a left paracentral corneal ulcer with stromal infiltrates following contact with a foreign body while riding a motorbike. Initial treatment with intensive topical antibiotic drops failed. Antifungal therapy with hourly topical amphotericin B 0.15% and fluconazole 0.2%, as well as oral fluconazole was initiated. His ulcer progressed rapidly despite aggressive treatment. This led to a small, peripheral corneal perforation which was treated with corneal gluing and bandage contact lens. He also developed secondary glaucoma. Microbiological cultures of his corneal scrapings revealed Arthrographis kalrae. A single dose of subconjunctival amphotericin B 0.015% o.1mL was then given. At two months after presentation, he eventually underwent therapeutic penetrating keratoplasty (PK) for non-resolving keratomycosis. Following PK, he was maintained on topical amphotericin B 0.15%, fluconazole 0.2% and ciprofloxacin 0.3% four-hourly, together with fusidic acid ointment 2% twice daily. The graft failed three months post-transplant, albeit with no evidence of residual or recurrent infection.Conclusion: Arthrographis kalrae-related keratitis may occur in non-contact lens wearer. Management remains clinically challenging because this organism causes severe, rapidly progressive keratitis.