RESUMO
CASO CLÍNICO: Un hombre de 51 años inmunocompetente nos fue remitido por presentar una gran úlcera corneal con hipopion en el ojo derecho. Inicialmente se le indicó anfotericina B, fluconazol y moxifloxacina tópicos e itraconazol por vía oral. Ante el reporte de estructuras micóticas en la tinción se administró natamicina tópica. El cultivo fue reportado dos semanas después indicando: Scedosporium apiospermum (S. apiospermum). Se añadió entonces voriconazol tópico. La respuesta al tratamiento fue muy lenta y solo hasta cinco semanas después de estar recibiendo el manejo típico triconjugado (natamicina, voriconazol y fluconazol) y de una dosis intraestromal de voriconazol, desapareció el hipopion. El resultado final fue exitoso, lográndose la cicatrización de la úlcera. El paciente está en espera de trasplante de córnea. DISCUSIÓN: En pacientes en quienes se sospeche queratitis micótica es indispensable el estudio microbiológico. El manejo de elección ante S. apiospermum es el voriconazol, pero puede requerirse la combinación de diversos agentes antifúngicos
CLINICAL CASE: A 51 year-old immunocompetent male was referred due to presenting with a large corneal ulcer with hypopyon in the right eye. Topical amphotericin B, fluconazole and moxifloxacin, as well as oral itraconazole were initially indicated. Following the report of mycotic structures on staining, topical natamycin was started. The result of the culture was reported two weeks later as, Scedosporium apiospermum (S. apiospermum), and topical voriconazole was then added. The response to treatment was very slow, and took five weeks after receiving triple therapy (natamycin, voriconazole and fluconazole) and one dose of intrastromal voriconazole, for the hypopyon to disappear. The final outcome was successful, achieving healing of the ulcer. The patient is waiting for a corneal transplant. DISCUSSION: A microbiological study is essential in patients in whom fungal keratitis is suspected. The treatment of choice against S. apiospermum is with voriconazole, but the combination of various antifungal agents may be required
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Scedosporium/isolamento & purificação , Ceratite/complicações , Ceratite/diagnóstico por imagem , Imunocompetência , Úlcera da Córnea/diagnóstico , Úlcera da Córnea/tratamento farmacológico , Reprodutibilidade dos Testes , Antifúngicos/uso terapêutico , Scedosporium , Cicatrização , Corpos Estranhos/complicações , Soluções Oftálmicas/uso terapêutico , Voriconazol/uso terapêutico , Administração TópicaRESUMO
CLINICAL CASE: A 51 year-old immunocompetent male was referred due to presenting with a large corneal ulcer with hypopyon in the right eye. Topical amphotericin B, fluconazole and moxifloxacin, as well as oral itraconazole were initially indicated. Following the report of mycotic structures on staining, topical natamycin was started. The result of the culture was reported two weeks later as, Scedosporium apiospermum (S. apiospermum), and topical voriconazole was then added. The response to treatment was very slow, and took five weeks after receiving triple therapy (natamycin, voriconazole and fluconazole) and one dose of intrastromal voriconazole, for the hypopyon to disappear. The final outcome was successful, achieving healing of the ulcer. The patient is waiting for a corneal transplant. DISCUSSION: A microbiological study is essential in patients in whom fungal keratitis is suspected. The treatment of choice against S. apiospermum is with voriconazole, but the combination of various antifungal agents may be required.
