Cladorrhinum Bulbillosum Keratitis: Unraveling an Unusual Infection
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Cladorrhinum Bulbillosum Keratitis: Unraveling an Unusual Infection Radhika Natarajan 1 & Samip Mehta 1
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review To analyze the presentation and outcome of keratitis due to Cladorrhinum bulbillosum which is a rare species of fungus sparsely reported in literature. Recent Findings In the genus Cladorrhinum, C. bulbillosum is the only reported pathogenic species causing keratitis. There have been only 3 reported cases in the literature thus far. Summary Ours is the first reported case series of 4 patients with keratitis caused by the rare dematiaceous organism Cladorrhinum bulbillosum. This keratomycosis can be variably pigmented clinically. Even though it has a typical morphological appearance on microscopy, molecular testing in the form of PCR and DNA sequencing aids in the diagnosis. Keratomycosis caused by this organism can have a protracted clinical course but can be managed medically alone. The need for surgical intervention may arise only in non-responsive cases where there are coexistent ocular or systemic morbidities. Keywords Fungal keratitis . Keratomycosis . Cladorrhinum bulbillosum . Dematiaceous fungus . Unusual infection
Introduction Among the organisms that can cause keratomycosis, C. bulbillosum is very rare and the only reported pathogenic species from the genus Cladorrhinum. It causes keratitis in humans with only two reported cases so far. We wish to report a case series of 4 patients with keratomycosis caused by Cladorrhinum bulbillosum who presented at our tertiary eye care center in South India and the challenges we faced in treating this rare infectious keratitis.
Case Series 1. A 46-year-old man was referred from a peripheral eye care center with decreased visual acuity, redness, and watering in his right eye for 4 days and was on moxifloxacin eye drops 4 times/day at the time of presentation. The best corrected Snellen vision was 6/60 * Radhika Natarajan [email protected] 1
Medical Research Foundation Sankara Nethralalya, No. 41, old No. 18, College road, Nungambakkam, Chennai, Tamil Nadu, India
(logMAR-1) in the affected eye. Slit-lamp examination revealed a 3.5 by 4 mm epithelial defect with a circular anterior stromal infiltrate with hyphate edges and a 1 mm hypopyon. There was no pigmentation over the ulcerated area. Corneal scraping showed septate filamentous fungi on KOH mount which was later confirmed to be Cladorrhinum bulbillosum in culture. Treatment with hourly topical natamycin and voriconazole was initiated. Baseline liver function tests were done, and oral voriconazole tablet was started twice a day. The ulcer started healing slowly over the next 15 days, and the frequency of topical antifungals was reduced to 10 times a day. Repeat liver function tests at 2 weeks after initiation of oral antifungal therapy showed mild derangement of values which prompted us to stop the oral voriconazole. Subsequently the patient developed an increase in pain, watering, and photophobia wit
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