Exophiala lecanii-corni keratitis presenting as a serpiginous pigmented superficial lesion: a case report

Abstract

Rationale: Patients with bullous keratopathy (BK) treated by Descemet stripping automated endothelial keratoplasty (DSAEK) have a compromised cornea, due to the administration of topical steroid, postsurgical use of contact lenses, and impaired barrier function of the corneal epithelium by BK. We report a case of Exophiala lecanii-corni ( E lecanii-corni) keratitis presenting as a serpiginous pigmented superficial lesion after DSAEK. Patient concerns: An 81-year-old woman who had undergone cataract surgeries, suffered from decreased vision in the left eye. She was diagnosed BK and she underwent DSAEK. Two months after DSAEK, a pigmented superficial lesion developed on the left cornea. The lesion migrated and recurred repeatedly and she was referred to our department. Best corrected vision was 20/220. Diagnoses: Light microscopy of a corneal scraping revealed branching fungal hyphae. Fungal culture showed growth of a black colony, identified as E lecanii-corni by ribosomal DNA sequencing. Interventions: We started topical treatment with 1% voriconazole and 1.5% levofloxacin. Antifungal susceptibility testing showed that the minimum inhibitory concentration of voriconazole was 0.06 μg/mL. Outcomes: The lesion scarred after treatment for 3 months, and left best corrected vision improved to 20/40. Lessons: Genus Exophiala is known as 1 of the “black molds” and a cause of chromomycosis. This is the first description of E lecanii-corni keratitis, and pigmented corneal epithelial lesions may be characteristic of this fungal genus.

Microbial Community Characterization and Molecular Resistance Monitoring in Geriatric Intensive Care Units in China Using mNGS

“… 32 Citrobacter koseri is a Gram-negative bacterium of the family Enterobacteriaceae isolated by hand and commonly found in water, soil, and human intestine, 33 which causes brain abscesses, 34 skeletal muscle, 35 and skin infections 36 in immunocompromised populations such as neonates as a conditional pathogen. The fungi were Exophiala lecanii corni which infects the skin 37 and cornea 38 and Megasphaera elsdenii which causes endocarditis. 39 Despite strict adherence to hand hygiene protocols by healthcare personnel in the ICU, there remains a possibility of transmission of potentially weakly pathogenic microorganisms to bed areas and infusion pumps during medical procedures, resulting in infections among immunocompromised elderly patients.…”

Mycobial community assemblages in sink drains across a university campus

“…Exophiala lecanii-cornii has been reported to mainly result in superficial mycoses affecting skin and nails but, in a rare occurrence caused keratitis (Lee et al, 2016;Miyakubo et al, 2020;Zeng et al, 2007).…”

“…Moreover, it is known to efficiently remove volatile organic compounds (VOC) from the air, therefore potentially explaining its dominance in biofilms growing at the water‐air interface (Pirnie‐Fisker & Woertz, 2007; Woertz et al, 2001). Exophiala lecanii‐cornii has been reported to mainly result in superficial mycoses affecting skin and nails but, in a rare occurrence caused keratitis (Lee et al, 2016; Miyakubo et al, 2020; Zeng et al, 2007). Exophiala 's widespread distribution across a variety of indoor water source environments, and its ability to survive more challenging ecological pressures results in its unsurprising presence and dominance across sinks samples.…”