Queratitis micótica causada por Scedosporium apiospermum en paciente inmunocompetente
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Archivos de la sociedad española de oftalmologia, 1989-7286, Vol. 93, Nro. 12, 2018, p. 613-616
Publicado por
Elsevier
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Resumen
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.
Descripción
Abstract
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
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.
Palabras clave
Úlcera corneal, Inmunocompetente, Culture
Keywords
Corneal ulcer, Immunocompetent, Cultivo
Temáticas
Scedosporium apiospermum
Antifúngicos
Quimioterapia
Antifúngicos
Quimioterapia