From devastation to restoration: trichosporon asahii can be beaten

PurposeTo report the first case of fungal keratitis caused by T. asahii which is treated succesfully with penetran keratoplasty.MethodsA 79‐year‐old woman was attended to our clinic with pain and hyperemia in her left eye. The patient had undergone phacoemulsification and intraocular lens implantation surgery from her left eye 9 months ago, and after the surgery visual acuity had been reported 0,8. 4 months after the surgery bullous keratopathy was occurred and treated with bandage contact lens and topical steroids. When she was evaluated visual acuity was light perception and slit lamp examination showed in anterior segment a large keratitis area, central of keratitis area was melted, anterior chamber was shallow and hypopyon was occurred. In direct examination hyphae formation was seen.ResultsFluconazole 200 mg 2 × 1, Cefazolin 50 mg/ml gtt per hour, Voriconazole %1 gtt per hour, Cyclopentolate %1 3 × 1, Phenilephrin %2.5 3 × 1, Tropicamide %1 3 × 1, Acetozolamide 250 mg 2 × 1 treatment were started empirical until the culture and antibiograme were resulted. Culture was resulted and Trichosporon asahii was isolated. The microorganism was sensitive for voriconazole and fluconazole, resistant for amphotericin B. According to the antibiograme results, systemic fluconazole and topical voriconazole treatment were continued. The keratitis area was healed with medical treatment but cornea was spontaneously perforated in 15th day of treatment and penetrating keratoplasty was performed immediately. After penetrating keratoplasty visual acuity was reached 0.1 and corneal graft was clear.ConclusionsFungal keratitis is vision threatening corneal disease causing by corneal ulceration. Trichosporon is one of the uncommon agent for fungal keratitis. This is the first case reported as a fungal keratitis caused by T. asahii treated successfully with penetrating keratoplasty.