Refractory Scedosporium apiospermum Keratitis Successfully Treated with Combination of Amphotericin B and Voriconazole.

Aim. To report a case of refractory fungal keratitis caused by Scedosporium apiospermum. Methods. Interventional case report. Results. A 47-year-old Malay housewife presented with left eye cornea ulcer as her first presentation of diabetes mellitus. There was no history of ocular trauma, contact lens used, or cornea foreign body. Scedosporium apiospermum was isolated from the cornea scrapping. Her cornea ulcer initially responded well to topical Amphotericin B within 3 days but subsequently worsened. Repeat cornea scrapping also yields Scedosporium apiospermum. This refractory keratitis was successfully treated with a combination of topical Amphotericin B and Voriconazole over 6 weeks. Conclusion. Scedosporium apiospermum keratitis is an opportunistic infection, which is difficult to treat despite tight control of diabetes mellitus and intensive antifungal treatment. The infection appeared to have very quick onset but needed long duration of treatment to completely heal. Surgical debridement always plays an important role as a therapeutic procedure as well as establishes the diagnosis through repeat scrapping.

Excellent outcome of primary Neisseria meningitidis keratoconjunctivitis.

Infectious conjunctivitis is a very common presentation to medical professional and ophthalmologist all over the world. Although its typically self-limiting and treatable in almost all of the cases, but we need to be aware of the rare and potentially life threatening if the cause is not promptly identified and treated accordingly. In our case report, we highlighted the rare case of Neisseria meningitidis as a primary cause of keratoconjunctivitis. Neisseria meningitidis is a rare etiology of keratoconjunctivitis and its ocular presentations are quite similar with other bacterial or viral infection. The infection may potentially fatal if systemic invasion occurred, however with immediate and proper treatment the outcome is satisfactory. Early diagnosis and proper antibiotic treatment are critical to prevent systemic spread of the infection. Public health intervention is needed to prevent outbreak of the disease.

Cryptococcus meningitis in an immunocompetent teenage boy presented early with diplopia.

AIM: To report a case of cryptococcus meningitis in an immunocompetent teenager that presented early with diplopia and bilateral poor vision. METHODS: A case report RESULTS: A 17-year-old boy presented with blurring of vision in both eyes and diplopia for 3 weeks. It was associated with severe throbbing headaches, nausea and vomiting. He was also having low grade fever. On physical examination he was afebrile with no sign of meningism. His vision was 6/15 in both eyes with constricted visual field. Anterior segment was normal in both eyes. Extraocular muscles movement showed bilateral sixth nerve palsies. Fundoscopy revealed bilateral hyperaemic and slightly elevated optic disc. CT scan of the brain was normal with no evidence of intracranial mass or abnormal ventricles. Lumbar puncture revealed high opening pressure >300mmH(2)O. Cerebrospinal fluid (CSF) microscopically and culture showed presence of cryptococcus neoformans. This case was combinedly managed with neuro-medical team. Patient was started on intravenous Amphotericin B and fluconazole. His neurological symptoms recovered after a week. His vision was improved to 6/6 in both eyes with recovery of peripheral visual field. The diplopia improved with recovery of sixth nerve palsies in both eyes. Unfortunately, patient developed nosocomial lower respiratory tract infection and was treated for the problem. CONCLUSION: This case highlights the indolent nature of cryptococcus meningitis and the fact that the overt signs of meningism may not be present even in immunocompetent person. Diplopia may be one of the early presentations of meningitis patient.