Lattice dystrophy complicated by Cryptococcus curvatus infection

Abstract

AbstractPurpose To present a novel case of Cryptococcus curvatus (CC) keratitis in a patient with Lattice dystrophy (LD).Methods A 57 year old lady with a family history of LD had a right re‐graft for suspected recurrent lattice dystrophy. Her initial penetrating keratoplasty (PK) was in 2004 after which she kept good vision. 5 years later she developed a small ulcer caused by presumable Candida which healed completely following topical miconazole and short course of oral fluconazole. In 6 months she developed gutter, increasing astigmatism, recurrent erosions without inflammation and progressive peripheral opacities leading to a 2nd PK.Results Histology of the 2nd PK revealed amyloid deposits in both host and graft elements confirming recurrent LD. In addition the graft contained numerous yeasts within epithelium and stroma along scars from previous PK. The capsulated fungi were seen on PAS, grocott and mucicarmine stains. No inflammatory response was associated with the fungi. Microbiology confirmed these as (CC). On review of findings from initial infection, it seemed that Cryptococcus instead of Candida was indeed the causative agent of her previous ulcer. Interestingly, she had no history of local trauma prior to her first corneal ulceration and there was never evidence of infection elsewhere. Unfortunately, 2 years after the 2nd PK the graft developed new opacities that lead to a 3rd PK which revealed recurrent (CC) keratitis again without any inflammatory response. The left eye also had a corneal graft in 2009 given her underlying LD and mercifully has never been infected.Conclusion To our knowledge Cryptococcus curvatus keratitis was never described in English literature.In fact, it seems that this is the first description of ocular infection by this species.