A case of conjunctival ulcer and uveitis caused by   Acrophialophora  sp. in an immunocompromised patient; a case report and literature review.

We report the first case of invasive ophthalmologic infection by Acrophialophora sp. that was successfully treated using voriconazole (VRCZ). Acrophialophora spp., which has been reported to be an opportunistic pathogen, is rare thermotolerant soil fungus, but its pathogenicity remains unclear. A 77-year-old man had neutropenia and prostate carcinoma, and was receiving hemodialysis. His right eye had been infected for 2 days. His conjunctiva was congested and partially formed an abscess. Liposomal amphotericin B (L-AMB) was administered following systemic itraconazole. However, treatment was changed from L-AMB to systemic VRCZ and VRCZ eye drops because his eye symptoms worsened. Subsequently, his symptoms stopped worsening and his vision was maintained. Acrophialophora sp. was identified by analyzing regions of internal transcribed spacer and domain 1 and 2 of rRNA gene. He finished the systemic VRCZ for 7weeks. The mean minimum inhibitory concentration of VRCZ Acrophialophora spp. has been reported to be the lowest among various antifungal agents, and our results indicated the efficacy of VRCZ treatment against Acrophialophora sp. infection. Our results suggest that invasive Acrophialophora sp. infection may require long-term therapy. Further analysis of the clinical spectrum of Acrophialophora spp. infection and adequate treatment methods are required in the future. PMID: 29962481 [PubMed - as supplied by publisher]
Source: Japanese Journal of Infectious Diseases - Category: Infectious Diseases Authors: Tags: Jpn J Infect Dis Source Type: research