Interface de pós-laser ceratomileuse in situ Arthographis Kalrae ceratite

Fernández-Barrientos, Yolanda; Ramos-Suárez, Antonio; Fernández-Sánchez, Fernando; Tirado-Carmona, Antonio

doi:10.5935/0004-2749.20200004

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LETTERS • Arq. Bras. Oftalmol. 83 (1) • Jan-Feb 2020 • https://doi.org/10.5935/0004-2749.20200004 copiar

Interface de pós-laser ceratomileuse in situ Arthographis Kalrae ceratite

Autoria SCIMAGO INSTITUTIONS RANKINGS

RESUMO

Descrevemos um caso de ceratomicose por Arthographis kalrae após ceratomileusis por excimer laser. Uma mulher de 38 anos desenvolveu ceratite estromal oito semanas após a cirurgia refrativa. Ela desenvolveu infiltração estromal grave da córnea e uma leve inflamação do segmento anterior, que não pode ser tratada com voriconazol tópico a 1%, mas a natamicina tópica a 5% melhorou sua condição. Uma reativação dos síntomas de ceratomicose foi observada; portanto, tratamento mais prolongado foi administrado a paciente. Tem sido relatado que a ceratomicose por A. kalrae está associada à exposição ao solo e ao uso de lentes de contato. No entanto, a paciente, que vivía em um local rural, não estava envolvida em atividades de jardinagem e nem tinha histórico de uso de lentes de contato. Este é o primeiro caso de ceratomicose pós-refrativa por A. kalrae.

Descritores:
Ceratite/microbiologia; Infecções oculares fún gicas; Ceratomileuse assistida por excimer laser in situ; Pro cedimen tos cirúrgicos refrativos; Antifúngicos; Complicações pós-operatórias

Case Report	Risk factors	Visual acuity	Clinical findings	Topical and systemic antibiotics
Perlman et al.⁽¹1 Perlman EM, Binns L. Intense photophobia caused by Arthrographis kalrae in a contact lens-wearing patient. Am J Ophthalmol. 1997;123(4):547-9.⁾, 1997.	Soft contact lens	Initial 20/20	Epithelial defect corneal	Topical anphotericin B 0.15%
	Gardening activities	Final 20/20	Stromal haze	Oral Ketoconazole 100 mg/24h
			Corneal infiltrate
			Not feathery margins
			Endotelial plaque
			Anterior chamber reaction
Biser et al.⁽³3 Biser SA, Perry HD, Donnenfeld ED, Doshi SJ, Chaturvedi V. Arthrographis keratitis mimicking acanthamoeba keratitis. Cornea. 2004;23(3):314-7.⁾, 2004.	Dailies toric contact lens	Initial 20/50	Initial conjuntivitis	Topical anphotericin B 0.4%
	Gardening	Final 20/200	Stromal haze and corneal edema	Miconazol 10%
	Rinitis treated with oral loratadina and fluticasona nasal spray			Itraconazol 200 mg/12h
Thomas et al.⁽⁴4 Thomas BC, Zimmermann S, Völcker HE, Auffarth GU, Dithmar S. Severe Arthrographis kalrae keratomycosis in an immunocompetent patient. Cornea. 2011;30(3):364-6.⁾, 2011.	Soft contacts lens	Initial 20/50	Epithelial defect	Topical voriconazole 1%
		Final 20/100	Corneal infiltrate	Oral Voriconazole 200 mg/12h
			Corneal edema	Intravenous voriconazole >2 μg/mL
			Endothelial precipitates	Intracameral voriconazole
			Anterior chamber reaction	4 QPP
			Corneal perforation
Ramli et al.⁽⁵5 Ramli SR, Francis AL, Yusof Y, Khaithir TM. A severe case of arthrographis kalrae keratomycosis. Case Rep Infect Dis. 2013; 2013:851875.⁾, 2013.	Diabetes	Initial 20/40 Final	Epitelial infiltrate, feathery stromal infitratation, surrounding edema and endothelial plaque	Oral Vibracina 100 mg/day + oral fluconazol 200 mg/day
	Accidental foreign body inoculation.	Perception to light	Bad evolution, perforation	Topical amphotericin B + topical fluconazole
	Accidental foreign body inoculation.	Perception to light	Bad evolution, perforation	Topical QPP
Fernandez-Barrientos et al⁽⁹9 Fernandez-Barrientos Y, Ramos-Suárez A, Fernández-Sanches, F, Tirado-Carmona A. Post-laser in situ keratomileusis interface Arthrographic Kalrae keratitis. Arq Bras Oftalmol. 2019 . No prelo⁾, 2019.	Rural village resident	Initial 20/80	Estromal infiltrate	Topical natamycin 5% topical
	Rural village resident	Initial 20/80	Meelting flap over inflitated	Oral voriconazole 200 mg/12h oral
	Late postoperative corneal refractive surgery	Final 20/80	Anterior chamber reaction

Case report	Site of infection	Treatment
Degarve et al⁽¹⁰10 Degavre B, Joujoux JM, Dandurand M, Guillot B. First report of mycetoma caused by Arthrographis kalrae: successful treatment with itraconazole. J Am Acad Dermatol.1997; 37:318-320.⁾ , 1997.	Mycetoma	Itraconazole (4 months), resolved.
Chin-Hong, et al⁽¹¹11 Chin-Hong PV, Sutton DA, Roemer M, Jacobson MA, Aberg JA. Invasive fungal sinusitis and meningitis due to Arthrographis kalrae in a patient with AIDS.J Clin Microbiol. 2001 Feb;39:804-807.⁾, 2001.	Sinusitis and meningitis in AIDS	Itraconazole
	Sinusitis and meningitis in AIDS	Death after resolved
Xi et al⁽¹²12 Xi L, Fukushima K, Lu C, Takizawa K, Liao R, Nishimura K. First case of Arthrographis kalrae ethmoid sinusitis and ophthalmitis in the People's Republic of China. J Clin Microbiol.2004; 42:4828-4831.⁾, 2004.	Ethmoid sinusitis and ophthalmitis	Surgical + intravenous amphotericin B 50 mg/day, nystatin and topical fluconazol 0.2%; itraconazole (4 weeks); relapse; surgical +itraconazole 400 mg/day (3 weeks)
	Ethmoid sinusitis and ophthalmitis	Resolved, evisceration was required.
Pichon et al⁽¹³13 Pichon N, Ajzenberg D, Desnos-Ollivier M, Clavel M, Gantier JC, Labrousse F. Fatal-stroke syndrome revealing fungal cerebral vasculitis due to Arthrographis kalrae in an immunocompetent patient. J Clin Microbiol.2008; 46:3152-3155.⁾, 2008.	Cerebral vasculitis and meningitis	None
	Cerebral vasculitis and meningitis	Postmorten diagnostic
Volleková et al⁽¹⁴14 Volleková A, Lisalová M, Poczová M. Arthrographis kalrae, an uncommon causative agent of onychomycosis. Epidemiol Mikrobiol Imunol.2008; 57:53-56.⁾, 2008.	Onychomycosis
Sugiura et al⁽¹⁵15 Sugiura Y, Hironaga M. Arthrographis kalrae, a rare causal agent of onychomycosis, and its occurrence in natural and commercially available soils. Med Mycol.2010; 48:384-389.⁾ , 2010.	Onychomycosis	Oral terbinafine 125 mg/day + miconazole 1% topical (7 months), resolved
Diego Candela et al⁽¹⁶16 de Diego Candela J, Forteza A, García D, Prieto G, Bellot R, Villar S et al. Endocarditis caused by Arthrographis kalrae. Thorac Surg.2010; 90:4-5.⁾, 2010.	Endocarditis	Surgical + amphotericin B, voriconazole, posaconazole (4 months); relapse; posaconazol (6 months); relapse embolic phenomena and death
Vos et al⁽¹⁷17 Vos CG, Murk JL, Hartemink KJ, Daniels JM, Paul MA, Debets- Ossenkopp YJ. A rare pulmonary infection caused by Arthrographis kalrae. J Med Microbiol.2012; 61:593-595.⁾, 2012.	Lung infection, patient history of lymphoma	Lobectomy + intraconazol (2 weeks), resolved
Boan et al⁽¹⁸18 Boan P, Arthur I, Golledge C, Ellis D. Refractory Arthrographis kalrae native knee joint infection. Med Mycol Case Rep.2012; 1:112-114.⁾, 2012.	Native knee joint infection	Amphotericin B, posaconazole, terbinafine
	Native knee joint infection	Resolved after 18 months
Shainaghi et al⁽¹⁹19 Sainaghi PP, Rossati A, Buccheri C, Bargiacchi O, Garavelli PL, Andreoni S. Arthrographis kalrae arthritis: a new case report. Infez Med.2015; 23:192-194.⁾, 2015.	Knee arthitis after penetrating wound	Voriconazole, resolved
Ong et al⁽²⁰20 Ong DC, Khan R, Golledge C, Carey Smith R. Case report: Eumycetoma and mycotic arthritis of the knee caused by Arthrographis kalrae. J Orthop.2014; 27:140-144.⁾, 2014.	Knee arthitis after penetrating injury	Protesis, resolved
Denis et al⁽²¹21 Denis J, Sabou M, Degot T, Candolfi E, Letscher-Bru V. First case of Arthrographis kalrae fungemia in a patient with cystic fibrosis. Med Mycol Case Rep.2016; 30:14:8-11⁾, 2016.	Fungemia after lung transplantation	Capsofucina 50 mg/day, intravenous amphotericin B 3 mg/kg/day, death
Campoverde-Espinoza J et al⁽²²22 Campoverde Espinoza CJ, Carballo CM, Orlando MN, Hevia AI, Gómez Raccio AC, Di Giovanni D et al. Pulmonary infection by Arthrographis kalrae in patient with chronic granulomatous disease. Arch Argent Pediatr.2017; 115:458-461.⁾, 2017.		Posaconazole, resolved

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[1] Corresponding author: Yolanda Fernández-Barrientos. Health Agency Costa del Sol - Autovía A-7 Km 187 - 29603 - Marbella, Spain. E-mail: yfernandezbarrientos@gmail.com