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Infectious crystalline keratopathy caused by Cladosporium sp. after penetrating keratoplasty: a case report

Authors Stock R, Bonamigo E, Cadore E, Oechsler R

Received 7 April 2016

Accepted for publication 29 June 2016

Published 29 August 2016 Volume 2016:9 Pages 267—271

DOI https://doi.org/10.2147/IMCRJ.S110046

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Yusuke Okuma

Peer reviewer comments 3

Editor who approved publication: Professor Ronald Prineas


Ricardo Alexandre Stock,1 Elcio Luiz Bonamigo,2 Emeline Cadore,3 Rafael Allan Oechsler4

1Corneal Transplant Section, Santa Terezinha University Hospital, 2Department of Ophthalmology and Bioethics, 3University of Western Santa Catarina, Joaçaba, 4Cornea Department, Oftalmo Center Blumenau, Blumenau, Santa Catarina, Brazil

Background: Infectious crystalline keratopathy is a rare, progressive infection characterized by the insidious progression of branches and crystalline corneal opacities with minimal or no inflammation. This case report describes the evolution of an infectious crystalline keratopathy caused by Cladosporium sp., which developed after tectonic keratoplasty in a patient with a history of ocular trauma.
Case presentation: A 40-year-old Brazilian male was the victim of firework-induced trauma to the left eye, which resulted in a corneal laceration that could not be sutured as well as a severe traumatic cataract. The patient underwent penetrating keratoplasty and phacoemulsification. During postoperative follow-up, another therapeutic keratoplasty was required because unresponsive infectious keratitis was observed. The infiltrate’s characteristics were suggestive of infectious crystalline keratopathy; in particular, the infiltrate was insidious and progressive, and grayish-white branches appeared in the anterior corneal stroma. As different therapies were administered, inflammatory reactions ranging from mild to severe were observed. The infection was unresponsive to typical antifungal drugs. This lack of response most likely occurred due to steroid treatment and the diffuse corneal spread of an atypical microorganism, which was subsequently identified in culture as Cladosporium sp. After the second therapeutic keratoplasty, the patient’s eye integrity was successfully reestablished.
Conclusion: This study likely provides the first report describing a case of infectious crystalline keratopathy caused by Cladosporium sp. This case emphasizes the clinical characteristics and outcome of this type of keratitis.

Keywords: cornea, keratitis, Cladosporium, penetrating keratoplasty, corneal ulcer

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