Abstract

P 230

Arthrographis kalrae induced perforating corneal ulcer – clinical course and treatment with voriconazole

Bettina Thomas1, Stefan Zimmermann2, Hans-Eberhard Völcker1, Stefan Dithmar1
1Universitäts-Augenklinik Heidelberg, 2Hygiene Institut Heidelberg, Heidelberg

Objective
Arthrographis kalrae (A.kalrae) is a filamentous fungus isolated from soil and compost. It is a rare human pathogen. So far only three ocular infections have been reported in the literature.
Methods
A 42-year-old otherwise healthy soft contact lens wearer developed a unilateral central corneal ulcer.
Results
Repeated microbiological testing of ocular swabs (culture) initially yielded Candida albicans. Under treatment with topical clotrimazole the ulcer progressed and a corneal perforation required a keratoplasty à chaud. For prophylaxis the patient received fluconazole systemically and continuous topical clotrimazole. However, in two weeks time mycotic infiltrates developed at the edge of the keratoplasty which penetrated the corneal transplant and lead to a re-keratoplasty only one month after the first one. In the meantime the microbiological analysis of the first keratoplasty showed A. kalrae which was sensitive to voriconazole in the antimycogram. Only under high-dose serum level controlled voriconazole systemically as well as topical voriconazole the intraocular infection stabilized.
Conclusions
An ocular infection with A. kalrae is very rare. The microbiological differentiation of A. kalrae can be difficult. Only a high-dose serum level controlled voriconazole treatment systemically in combination with voriconazole eye drops were able to stabilize the A. kalrae keratitis. Since a broad spectrum of fungi is sensitive to voriconazole, the early topical and possibly systemic treatment is a reasonable therapeutic option when suspecting a mycotic infection of the eye.

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