PURPOSE: To discuss the role of voriconazole in the management of Alternaria keratitis. METHODS: Case report and literature review. RESULTS: A 69-year-old man with a history of corneal foreign body removal developed a stromal infiltrate 2 months later that did not improve despite topical antibiotics and natamycin. On our initial examination, visual acuity (VA) was 20/40, and he had a central, full-thickness, reticular appearing infiltrate. Oral clarithromycin was added because of the atypical pattern of the infiltrate. However, no improvement was noted. A repeat culture revealed coagulase-negative Staphylococcus. VA decreased to 20/200, and increased inflammation was noted a month later; a trial of topical steroids was added. After an initial improvement, he returned with progression. Repeat culture revealed Alternaria species, and topical amphotericin was started. When there was no response, he was admitted and switched to oral and topical voriconazole. Steady resolution was noted within 10 days of therapy. CONCLUSION: Suspicion must be maintained for unusual causes of infectious keratitis. Fungal infection can be difficult to eradicate even with traditional antifungals. Although not approved for ophthalmic use yet, voriconazole provided improvement with Alternaria keratitis unresponsive to amphotericin.
PURPOSE: To discuss the role of voriconazole in the management of Alternaria keratitis. METHODS: Case report and literature review. RESULTS: A 69-year-old man with a history of corneal foreign body removal developed a stromal infiltrate 2 months later that did not improve despite topical antibiotics and natamycin. On our initial examination, visual acuity (VA) was 20/40, and he had a central, full-thickness, reticular appearing infiltrate. Oral clarithromycin was added because of the atypical pattern of the infiltrate. However, no improvement was noted. A repeat culture revealed coagulase-negative Staphylococcus. VA decreased to 20/200, and increased inflammation was noted a month later; a trial of topical steroids was added. After an initial improvement, he returned with progression. Repeat culture revealed Alternaria species, and topical amphotericin was started. When there was no response, he was admitted and switched to oral and topical voriconazole. Steady resolution was noted within 10 days of therapy. CONCLUSION: Suspicion must be maintained for unusual causes of infectious keratitis. Fungal infection can be difficult to eradicate even with traditional antifungals. Although not approved for ophthalmic use yet, voriconazole provided improvement with Alternaria keratitis unresponsive to amphotericin.
Authors: Daoud Al-Badriyeh; Lok Leung; Trent Roydhouse; Robert Fullinfaw; Mark Daniell; Geoffrey E Davies; Kay Stewart; David C M Kong Journal: Antimicrob Agents Chemother Date: 2009-05-11 Impact factor: 5.191
Authors: Namperumalsamy V Prajna; Jeena Mascarenhas; Tiruvengada Krishnan; P Ravindranath Reddy; Lalitha Prajna; Muthiah Srinivasan; C M Vaitilingam; Kevin C Hong; Salena M Lee; Stephen D McLeod; Michael E Zegans; Travis C Porco; Thomas M Lietman; Nisha R Acharya Journal: Arch Ophthalmol Date: 2010-06
Authors: Chin Fen Neoh; Lok Leung; Elsie Chan; Daoud Al-Badriyeh; Robert O Fullinfaw; Vishal Jhanji; Rasik B Vajpayee; Geoffrey E Davies; Kay Stewart; David C M Kong Journal: Antimicrob Agents Chemother Date: 2016-10-21 Impact factor: 5.191