Phialophora chinensis fungal keratitis: An initial case report and species identification

Briana Ply; Connie F Cañete-Gibas; Carmita Sanders; Nathan P Wiederhold; Rachel A Dandar; John D Sheppard; Albert Y Cheung

doi:10.1016/j.ajoc.2023.101800

Phialophora chinensis fungal keratitis: An initial case report and species identification

Am J Ophthalmol Case Rep. 2023 Jan 19:29:101800. doi: 10.1016/j.ajoc.2023.101800. eCollection 2023 Mar.

Authors

Briana Ply¹, Connie F Cañete-Gibas², Carmita Sanders², Nathan P Wiederhold², Rachel A Dandar¹, John D Sheppard^{1

3}, Albert Y Cheung^{1

3}

Affiliations

¹ Department of Ophthalmology, Eastern Virginia Medical School, Norfolk, VA, USA.
² Department of Pathology and Laboratory Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.
³ Virginia Eye Consultants/CVP Physicians, Norfolk, VA, USA.

Abstract

Purpose: To report the initial case of microbial keratitis caused by Phialophora chinensis, a rare cause of fungal keratitis.

Observations: A 66-year-old gentleman with a complex right eye (OD) ocular history including herpes simplex virus infectious epithelial keratitis with subsequent neurotrophic keratopathy, and prior combined Candida albicans and parapsilosis fungal keratitis presented with pain OD in the absence of an antecedent trauma. The patient was found to have a filamentous fungal keratitis, which was subsequently cultured and identified as Phialophora chinensis by the laboratory. Despite topical and oral antifungal treatment based on sensitivities determined by the lab, the patient ultimately required intrastromal and subconjunctival antifungal injections, corneal crosslinking, and superficial keratectomy with amniotic membrane to clinically improve. The fungal keratitis recurred twice, with each occurrence rapidly progressing to corneal perforation. Months after the second penetrating keratoplasty, the patient's mental status declined due to multiorgan failure. An occult pulmonary malignancy was discovered during this hospital stay, and the patient was lost to follow-up after entering hospice.

Conclusions and importance: We report a unique case of fungal keratitis caused by Phialophora chinensis and the subsequent management, including both medical and surgical interventions. Despite a multimodal treatment regimen, this case demonstrates the recalcitrant and potentially recurrent nature of fungal keratitis caused by P. chinensis.

Keywords: CXL, corneal cross-linking; Corneal collagen crosslinking; Corneal ulcer; FTL, Fungus Testing Laboratory; Fungal keratitis; GHJ, graft-host-junction; HSV, herpes simplex virus; MIC, Minimum inhibitory concentrations; OA, oatmeal agar; OD, Right eye; OS, Left eye; PFA, potato flakes agar; PK, Penetrating keratoplasty; Perforation; Phialophora chinensis; RFLP, restriction fragment length polymorphisms.

Publication types

Case Reports