First case of fungal keratitis caused by Pestalotiopsis clavispora

Yu Monden,¹ Shohaku Yamamoto,¹ Ryoji Yamakawa,¹ Atsuko Sunada,² Seishi Asari,³ Koichi Makimura,⁴ Yoshitsugu Inoue<sup>5

1</sup>Department of Ophthalmology, Kurume University School of Medicine, Fukuoka, ²Laboratory for Clinical Investigation, ³Department of Infection Control and Prevention, Osaka University Hospital, Osaka, ⁴Teikyo University Institute of Medical Mycology, Tokyo, ⁵Division of Ophthalmology and Visual Sciences, Tottori University Faculty of Medicine, Tottori, Japan

Purpose: To report the isolation of Pestalotiopsis clavispora from the cornea of a patient with recurrent keratitis.
Case report: A 73-year-old male gardener presented with conjunctival injection and an oval infiltrate with feathery margins in the temporal half of the cornea in the right eye. His ocular history in the right eye included cataract surgery, five episodes of herpes simplex keratitis, three glaucoma surgeries, and bullous keratopathy. He had been treated with corticosteroids for years. Light microscopy of corneal scrapings revealed a filamentous fungus, and fungal keratitis was diagnosed. Treatment with topical voriconazole and pimaricin ointment was commenced. One month later, the infiltrate resolved. The antifungal agents were discontinued 7 months later, and keratitis relapsed 4 days after the discontinuation. The fungus was isolated and identified by molecular techniques as P. clavispora. Based on the results of antifungal susceptibility testing, treatment with topical and intravenous micafungin was initiated. The corneal infiltrate resolved 1 month after the relapse.
Conclusion: Molecular identification of the pathogen, and antifungal susceptibility testing, are useful in treating patients with fungal keratitis caused by a rare human pathogen.

Keywords: fungal keratitis, Pestalotiopsis clavispora, plant pathogen, molecular identification, antifungal susceptibility test