Arthrographis kalrae Keratitis Complicated by Endophthalmitis: A Case Report With Literature Review

Abstract

Objectives: To report the first case of Arthrographis kalrae keratitis complicated by endophthalmitis in the UK and to review the current literature. Methods: A case report with literature review. Results: A 65-year-old male patient, with a background of treated B-cell lymphoma and herpes simplex virus-related neurotrophic keratopathy, presented with a large infiltrative corneal ulcer in the right eye. The patient was immediately commenced on empirical antifungal treatment in view of the clinical suspicion of fungal keratitis (FK). The initial corneal scrape identified the organism as nonspecific “mold,” and the identity of A. kalrae was subsequently confirmed using matrix-assisted laser/desorption ionization-time of flight-mass spectrometry (MALDI-TOF-MS). During the clinical course, the patient received topical, intrastromal, intracameral, and systemic antifungal treatment, repeat therapeutic corneal cross-linking treatment, and three penetrating keratoplasties. Although a temporary improvement was achieved with therapeutic corneal cross-linking treatment, the FK progressed relentlessly and was ultimately complicated by an endophthalmitis despite maximum medical and surgical treatment, eventuating in an enucleation. Conclusions: A. kalrae keratitis is an exceptionally rare clinical entity that poses significant therapeutic challenges. MALDI-TOF-MS serves as a useful diagnostic technique in identifying this rare organism. Although the literature suggested that A. kalrae keratitis may sometimes be controlled with antifungal medical treatment alone, this approach was proven to be futile in our immunocompromised patient with pre-existing neurotrophic keratopathy, suggesting that early surgical intervention such as therapeutic keratoplasty may be required in these cases.

Post-keratoplasty Infectious Keratitis: Epidemiology, Risk Factors, Management, and Outcomes

“…A number of complications have been documented in the literature following PKIK, including graft rejection, failure, and endophthalmitis requiring evisceration/enucleation ( 25 , 33 , 42 , 43 , 48 , 96 , 159 ). Graft rejection and/or failure was found to occur in 7.3–71.4% cases ( 10 , 12 , 25 , 26 , 28 , 43 , 45 , 49 ).…”

Amniotic membrane transplantation for infectious keratitis: a systematic review and meta-analysis

“…agricultural practice, trauma, use of contact lens and others), bacteria and fungi have been shown to be the main causative microorganisms for IK, followed by viruses, parasites and polymicrobial infection 2 – 7 . Broad-spectrum topical antimicrobial therapy is currently the gold standard for managing IK in routine clinical practice, though eye-saving procedures such as corneal gluing, therapeutic photoactivated chromophore-corneal cross-linking (PACK-CXL), amniotic membrane transplantation (AMT), and therapeutic keratoplasty may be required in recalcitrant cases 8 – 14 .…”

Clinical Spectrum and Outcomes of Ocular and Periocular Complications following External-Beam Radiotherapy for Inoperable Malignant Maxillary Sinus Tumors

“…Future studies evaluating the prophylactic role of AMT in reducing the risk and severity of radiation keratopathy after high-dose orbital/periorbital EBRT will be valuable. In view of the potential utility of PACK-CXL in treating fungal keratitis, [29, 30] this adjuvant treatment was employed to treat 1 patient affected by refractory candida keratitis (Patient 4). However, the cornea failed to respond to the treatment and perforated 2 days later, which necessitated an emergency tectonic keratoplasty.…”