56 year old patient, housewife, pedicurist and manicurist, with no history of systemic or ocular diseases, first-time user of CL lotrafilcon B in adaptation period of three months.
He slept with his lenses weekly and removed them on weekends for cleaning.
There was no eye discomfort, and a week was missing for the change to the new pair of lenses.
On the night before the consultation she presented intense pain, photophobia and blepharospasm.
On admission he had a severe corneal ulcer in his left eye.
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Upon opening the box at admission, a black spot was found, visible to the naked eye, which corresponded to mycelium with aseptate and detritus hyphae, microscopic observation (40X) with direct lactophenol color.
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The surface of the lens, observed at the entrance, showed to be radiated and bad.
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The corneal control revealed conjunctival hyperemia associated with a central lesion with regular borders, 6 mm in diameter, and hypo-pion.
There were no satellite infiltrates or perikeratic ring.
Abundant purulent secretion in the conjunctival sac.
The patient had permanent tattooing as seen in the picture.
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For the microbiological analysis, box, contact lens and multipurpose solution were placed in Saboureaud agar at 22 °C and agar manitol agar at 37 °C for microbiological isolation at 37 °C.
After four days of inoculation, Aspergillus sp. grew in Saboureaud agar from the lens sheath and the multipurpose solution.
The growth was negative for Staphylococcus sp and positive for agarrimide for P. aeruginosa, the latter being sensitive to ciprofloxacin, tobramycin, gentamicin, moxifloxacin in the diffusion antibiogram.
The samples were sent to another laboratory and the same result was confirmed.
The patient was monitored until no hypopion was observed.
Subsequently, in the presence of Pseudomonas sp, the patient was asymptomatic, with reactive pupil and absence of central closure slowly.
Diclofenac, flurometalone and 1% atropine were indicated.
At day 18 the patient did not present photophobia, but a central residual leukoma was observed.
At the third month of treatment, she was referred for keratoplasty, which was performed at six months of evolution.
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The presence of Aspergillus sp reported in the box and contact lens led to corneal colonization.
However, due to the clinical evolution, the absence of infection in the corneal culture and perhaps due to immediate treatment with natamycin, an infection that had the risk of endophthalmitis was achieved.
It is well known that Pseudomonas sp opens the corneal epithelium allowing entry of the parasite.
After six months of evolution and after obtaining a donor, the patient was scheduled for keratoplasty.
