Alternaria Keratitis

A patient with a history of a failed DMEK who required a DSAEK, was referred to the BPEI's cornea department after a 1-month history of culture-confirmed Alternaria keratitis that developed after the DSAEK. The ulcer progressed despite topical and systemic antifungal treatment. Slit lamp examination revealed lid and conjunctival injection, as well as a central infiltrate with stromal necrosis that was denser in the inferotemporal area. This clinical picture could represent a variety of diagnoses, such as interface keratitis, neurotrophic keratitis, or infection from bacterial, viral, or amoebic species. An anterior segment OCT confirmed anterior corneal compromise, ruling out interface keratitis, and corneal scraping histopathology confirmed a fungal source. The patient was treated with topical natamycin, amphotericin B, voriconazole, and cyclosporine, as well as systemic Posaconazole and doxycycline. He was closely monitored until the infection cleared up, at which point he underwent optical penetrating keratoplasty, achieving a best corrected visual acuity of 20/30 four months later. The patient is currently being monitored by his primary ophthalmologist.

Presentation Date: 09/15/2022

Issue Date: 09/30/2022