Invasive Fungal Keratitis as an Uncommon Form of Mucormycosis Leading to Endophthalmitis: Report of Two Cases and Literature Review

Abstract

This study was conducted to report two cases of fungal keratitis caused by mucormycetes that led to endophthalmitis. Case number 1: a 24-year-old male, with a known case of thalassemia major, presented with chief complaints of painful periorbital edema and redness in the left eye. Intravenous antibiotics were prescribed upon diagnosis of orbital cellulitis, but it progressed to the cornea and sclera and led to endophthalmitis, which was treated with penetrating keratoplasty (PK) combined with deep vitrectomy. Case number 2: a 6-year-old healthy boy presented to the ophthalmology emergency room with ocular pain and redness in his right eye. He had a history of swimming in a river 2 weeks prior to presentation. At the time of presentation, eye examinations showed a dense stromal infiltration with hypopyon. He underwent therapeutic PK due to progression of infiltration to the total cornea and limbus. After the first PK, the patient underwent combined Re-PK and deep vitrectomy, because of recurrence of infection on graft and development of endophthalmitis. The infection relapsed on corneal graft and visual acuity decreased to no light perception. For this patient, enucleation was performed in order to prevent spread of infection to the orbit and brain. Fungal keratitis caused by mucormycetes as an uncommon infection might occur in healthy individuals. Accordingly, timely diagnosis and administration of appropriate antimicrobial agents are vital. In fungal keratitis, patients who have intraocular involvement and are unresponsive to initial antifungal therapy should be evaluated regarding suspicion of mucormycetes.