Bilateral nummular infiltrates: An uncommon presentation of Candida keratitis

Purpose: We present a case of misdiagnosed fungal keratitis due to a bilateral nummular presentation. Observations: A 41-year-old female patient, contact lens wearer, presented initially at an optometrist with acute bilateral blurred vision and photophobia. She was found on exam to have multiple rou...

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Autores principales:	Deena Dahshan, Charles D. Francis, Maya S. Bitar
Formato:	article
Lenguaje:	EN
Publicado:	Elsevier 2021
Materias:	Nummular keratitis Candida albicans Mycotic Cornea Ophthalmology RE1-994
Acceso en línea:	https://doaj.org/article/cb88bff29abf4b08baee922f792a2374
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spelling	oai:doaj.org-article:cb88bff29abf4b08baee922f792a23742021-11-12T04:43:08ZBilateral nummular infiltrates: An uncommon presentation of Candida keratitis2451-993610.1016/j.ajoc.2021.101233https://doaj.org/article/cb88bff29abf4b08baee922f792a23742021-12-01T00:00:00Zhttp://www.sciencedirect.com/science/article/pii/S2451993621002425https://doaj.org/toc/2451-9936Purpose: We present a case of misdiagnosed fungal keratitis due to a bilateral nummular presentation. Observations: A 41-year-old female patient, contact lens wearer, presented initially at an optometrist with acute bilateral blurred vision and photophobia. She was found on exam to have multiple round stromal infiltrates bilaterally. She did not have significant ocular surface issues prior and had no history of topical steroid use. Adenovirus testing was negative, and she was started on a topical antibiotic-steroid combination. She did not improve and was referred for further evaluation. We initially suspected a herpetic infection and began treatment with oral antivirals. Cultures came back positive for Candida albicans in the right eye. She was very photophobic and cultures were unable to adequately be obtained from the left eye. She was switched to topical voriconazole drop in both eyes and gradually improved with excellent visual outcome. Urogenital cultures were negative. Contact lens use was discontinued through the course of treatment. Conclusions: Bilateral Candida keratitis is rare and has not been reported in a nummular pattern and in a patient without significant ocular surface issues or chronic use of steroid drops. Differential diagnosis of nummular keratitis mostly includes viral and inflammatory conditions. This case highlights the need to stay alert to a possible fungal etiology and a potential risk of using topical steroids at initial presentation of nummular keratitis.Deena DahshanCharles D. FrancisMaya S. BitarElsevierarticleNummular keratitisCandida albicansMycoticCorneaOphthalmologyRE1-994ENAmerican Journal of Ophthalmology Case Reports, Vol 24, Iss , Pp 101233- (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Nummular keratitis Candida albicans Mycotic Cornea Ophthalmology RE1-994
spellingShingle	Nummular keratitis Candida albicans Mycotic Cornea Ophthalmology RE1-994 Deena Dahshan Charles D. Francis Maya S. Bitar Bilateral nummular infiltrates: An uncommon presentation of Candida keratitis
description	Purpose: We present a case of misdiagnosed fungal keratitis due to a bilateral nummular presentation. Observations: A 41-year-old female patient, contact lens wearer, presented initially at an optometrist with acute bilateral blurred vision and photophobia. She was found on exam to have multiple round stromal infiltrates bilaterally. She did not have significant ocular surface issues prior and had no history of topical steroid use. Adenovirus testing was negative, and she was started on a topical antibiotic-steroid combination. She did not improve and was referred for further evaluation. We initially suspected a herpetic infection and began treatment with oral antivirals. Cultures came back positive for Candida albicans in the right eye. She was very photophobic and cultures were unable to adequately be obtained from the left eye. She was switched to topical voriconazole drop in both eyes and gradually improved with excellent visual outcome. Urogenital cultures were negative. Contact lens use was discontinued through the course of treatment. Conclusions: Bilateral Candida keratitis is rare and has not been reported in a nummular pattern and in a patient without significant ocular surface issues or chronic use of steroid drops. Differential diagnosis of nummular keratitis mostly includes viral and inflammatory conditions. This case highlights the need to stay alert to a possible fungal etiology and a potential risk of using topical steroids at initial presentation of nummular keratitis.
format	article
author	Deena Dahshan Charles D. Francis Maya S. Bitar
author_facet	Deena Dahshan Charles D. Francis Maya S. Bitar
author_sort	Deena Dahshan
title	Bilateral nummular infiltrates: An uncommon presentation of Candida keratitis
title_short	Bilateral nummular infiltrates: An uncommon presentation of Candida keratitis
title_full	Bilateral nummular infiltrates: An uncommon presentation of Candida keratitis
title_fullStr	Bilateral nummular infiltrates: An uncommon presentation of Candida keratitis
title_full_unstemmed	Bilateral nummular infiltrates: An uncommon presentation of Candida keratitis
title_sort	bilateral nummular infiltrates: an uncommon presentation of candida keratitis
publisher	Elsevier
publishDate	2021
url	https://doaj.org/article/cb88bff29abf4b08baee922f792a2374
work_keys_str_mv	AT deenadahshan bilateralnummularinfiltratesanuncommonpresentationofcandidakeratitis AT charlesdfrancis bilateralnummularinfiltratesanuncommonpresentationofcandidakeratitis AT mayasbitar bilateralnummularinfiltratesanuncommonpresentationofcandidakeratitis
_version_	1718431258199982080

Bilateral nummular infiltrates: An uncommon presentation of Candida keratitis

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