Clinical and Confocal Microscopy Findings of Fungal Keratitis Caused by Zygomycota: A Case Report

Abstract

Purpose: To describe a case of fungal keratitis caused by Zygomycota, diagnosed using confocal microscopy, and its clinical management.Methods: Case report.Results: The patient was an 18-year-old Taiwanese female with no past history of ocular trauma. Recently, she had been wearing soft contact lenses when swimming, and she experienced redness, photophobia, and painful sensations of the left eye for the past 3 weeks. Before hospitalization, she suffered from rapidly decreasing visual acuity of the left eye. The best-corrected visual acuity were 6/6 in the right eye and hand movement in the left eye. Slit-lamp examination showed serious central corneal infiltration and ulceration of the left eye. Microscopy with potassium hydroxide (KOH) staining of corneal scrapings revealed aseptate hyphae with sharp right-angle branches. Confocal microscopy confirmed the detailed fungal structure of zygomycota in the anterior stromal layer of the left eye. She received combined topical antifungal and antibiotic therapy. No fungal cultures showed any growth. Fortunately, the patient achieved a good visual outcome after treatment, with a best-corrected visual acuity of 6/12 of the left eye after 6-months' follow-up.Conclusion: Fungal keratitis is usually encountered in the clinic after ocular trauma or inappropriate contact lens wearing. In our case, the KOH stain and confocal microscopy helped us to quickly and accurately diagnose fungal keratitis caused by Zygomycota. Rapid diagnosis, aggressive topical antifungal therapy, and surgical debridement of necrotic material are efficacious at promoting infection control and achieving a good prognosis for visual outcome.