A 60-year-old farmer with a history of ocular trauma with plant material consulted for a sudden decrease in visual acuity of 48 h of evolution, accompanied by moderate eye pain and photophobia.
On examination, the right eye had a visual acuity of 20/100 with normal anterior segment and the left eye with a diffuse good color in the four quadrants and a central ulcer of 0.6 x 0.6 mm with edges.
The patient reported a two-year history of arterial hypertension as co-morbidity.
A clinical diagnosis of infectious etiology was made.
A sample of the ulcer was taken for microbiological study and immediately topical treatment with fluconazole 0.2% and moxifloxacin 0.5% every 1 hour was initiated.
At 24 h, in the first control, direct examination revealed the presence of fungal elements, adding 5% natamycin every 1 hour and topical mycofloxacin every 3 hours.
Since the patient complained of severe eye pain, atropine eye drops were prescribed three times a day.
In the second control, at 48 h, moderate conjunctival hyperemia and three satellite lesions were observed.
In the third control, at 72 h, the patient complained of very severe ocular pain, so atropine in drops was again prescribed.
The corneal defect and the satellite lesions remained unchanged.
Treatment was continued with natamycin and topical fluconazole and moxifloxacin in drops, 4 times a day.
After one week, the patient reported less ocular pain and slight improvement of the lesion was observed, so moxifloxacin was discontinued.
In the following six controls, the satellite lesions were no longer visible, there was a decrease in corneal flaps, the size of the arch decreased to 0.5 x 0.5 mm and the patient no longer referred pain.
After 41 days of treatment the absence of activity in the lesion was observed; however, the corneal scar persisted.
The last control was performed three months after ocular trauma, when cataract surgery and corneal transplantation were recommended due to corneal healing.
Microbiological study
The scraping material of the corneal lesion was performed by the ophthalmologist with Kimura spatula and sent for microbiological study to the Institute of Health Sciences Research.
In the fresh examination with 10% KOH (40X) and Gram stain branched septate hyphae were observed.
Bacterial cultures were performed in thioglycolate broth at 35°C and in blood agar and chocolate agar in 5% CO2 atmosphere at the same temperature; all were negative.
The cultures without staining were performed on Sabouraud agar and potato agar dextrose and inoculated at 28°C. A 72 hcure taking mycelium dye was finally disseminated. The colony development was initially flaccid, with pigmentation.
The colony was referred to the Department of Mental Disorders of the Instituto de Medicina Regional do Nordeste (Argentina) for identification.
Micromorphology revealed dark brown to black pycnidia with septate hyaline paraphyses.
Epileptic elliptical conidia of (18-30) x (10-15) μηι, initially hyaline and non-septated, were observed in dark brown color with a mid-septate septa.
Isolates were identified as Candidiasis theobromae (Patdia theobromae).
Griffon & Maubl., according to the bibliographic reference of Alves et al.
1.
Antifungal sensitivity was not determined because it is not routinely performed and there is no standard methodology for screening sensitivity for this condition.
