Fili S, Schilde T, Perdikakis G and Kohlhaas M
Backgrounds: To report 2 cases of multidrug-resistant fungal keratitis caused by Fusarium solani. The patients underwent a different conservative and surgical therapy including in both of them a keratoplasty à chaud. Methods and findings: A 21-years-old male and a 26- years-old female patient, who both used soft contact lenses developed corneal infiltrates. In the first case the diagnosis was delayed because multiple microbiological examinations of corneal scrapings were initially negative for fungi. A combined empirical therapy against Acanthamoeba and bacteria resulted in no improvement of the clinical findings. The patient underwent a keratoplasty à chaud and the histopathologic analysis of the corneal button yielded Fusarium solani multiresistant to all antifungal agents. In the second case, Fusarium solani was detected in the initial microbiological examination of the corneal scrapings. Although the fungus was multiresistant to all antifungal agents, an aggressive multiple topical antifungal therapy as well as lyposomal Amphotericin B i.v was applied successfully after the keratoplasty à chaud combined with application of Polyvidon-Iodine on the infected cornea and cryocoagulation circular at limbus. Results: Although a therapy with topical Amphotericin B and systemic lyposomal Amphotericin B was applied by the first case the infection progressed to an endophthalmitis. Unfortunately an enucleation was unavoidable. The multiple conservative antifungal therapy in the second case was successful, and the corneal transplant remained free from new infiltrations. Conclusion: We consider the fast diagnosis of multidrug resistance of great importance. Secondly, a penetrating keratoplasty early on the course of the disease increases the chances of a successful outcome.
