Título

CONIOCHAETA MUTABILIS KERATITIS WITH AN UNUSUAL MODE OF TRANSMISSION TREATED WITH PENETRATING KERATOPLASTY AND SYSTEMIC ANTIFUNGALS

Objetivo

Ocular infections with Coniochaeta mutabilis (previously known as Lecythophora mutabilis) have been described only a few times in literature: one case of endophthalmitis, one case of blebitis, and one case of keratitis-endophthalmitis, along with another report of keratitis caused by an unspecified organism belonging to the Lecythophora genus. All reported cases were aggressive in nature and one of them showed recurrence after deep anterior lamellar keratoplasty (DALK). We report a case of C. mutabilis keratitis that possibly derived from an unusual mode of transmission and demonstrated complete remission after penetrating keratoplasty (PKP), performed with intracameral voriconazole administration and associated to systemic antifungal medications.

Relato do Caso

A 52-year-old woman presented with a corneal ulcer following a week of increasing eye pain. Five months prior, she had a corneal abrasion in the same eye that resulted from trauma during yard work. Two weeks before presentation, she cared for a chicken with ocular infection. Culture of the corneal scraping identified Coniochaeta mutabilis, a rarely described fungal pathogen. After multiple treatment modalities were attempted, the patient ultimately underwent penetrating keratoplasty with intracameral voriconazole rinse, with a sequence of oral posaconazole 7 days before and 7 days after. No signs of infection recurrence were present during follow-up after the procedure.

Conclusão

C. mutabilis keratitis is a rare condition that typically presents with an aggressive nature and requires multiple forms of treatment. Here, we report direct contact with an infected chicken cornea as a possible mode through which the disease was acquired. Early suspicion of fungal etiology in cases of keratitis allows directed treatment, which may improve visual outcomes. Acknowledging unusual modes of transmission may help bring this differential diagnosis into consideration. Furthermore, given the scarcity of literature about this disease, individual case reports are informative for guiding future treatment and research.