Posters

Fungal conjunctivitis in an immunocompetent patient: a challenging diagnosis

Poster Details

First Author: I.Jeddou MOROCCO

Co Author(s):    S. Belfaiza   H. Brarou   M. Belmalih   F. Elasri   K. Reda   A. Oubaaz     

Abstract Details

Purpose:

Fungal conjunctivitis is unusual. It occurs generally in patients with underlying health conditions and the most common ætiology is candida albicans. Mucormycosis is a rare emerging fungal infection with high morbidity and mortality. The typical invasion of mucormycosis will gradually lead to extensive necrosis and thus to devastating consequences which could be lethal. Rarity and non-specificity of the clinical presentation of ocular mucormycosis make it difficult to make the diagnosis promptly. Thus, early diagnosis is important and is the main target of recent researches. The purpose of our presentation is to raise awareness among ophthalmologists about fungal conjunctivitis.

Setting:

Ophthalmology department of the Military Training Hospital Mohamed V of Rabat. Morocco.

Methods:

The authors report a unique case of Mucormycosis conjunctivitis occurring in an immunocompetent 38 years-old woman.

Results:

A healthy 38 years-old woman consults for redness and discharge of her left eye. The examination shows eyelid edema, chemosis and necrosis of the inferior bulbar conjunctiva. Conjunctival swabbing was taking for microbiology which revealed coagulase-negative staphylococcus. But there was no improvement after antibiotic therapy. We made debridement of the conjunctival lesion of which histopathology showed neutrophilic and granulomatous inflammation with suppurative necrosis. This, in addition to the atypical presentation of the conjunctivitis (necrosis, golden granules' secretions) suggests a fungal ætiology. Conjunctival scrapes sent to microbiology revealed Mucormycetes. The treatment was based on topical and general Amphotericin-B with positive evolution.

Conclusions:

This case had three interesting points: 1. The patient was young with no underlying conditions. 2. Mucormycosis infection was unusually only located on the eye. 3. Conjunctival swabbing was negative when conjunctival scrapes were positive to Mucormycosis. Based on the above points, we can conclude that: - Atypical clinical presentation and resistance to usual treatment should suggest fungal infection even in immunocompetent patients. - Conjunctival scraping is more efficient to isolate fungi. - Rapid diagnosis of Mucormycosis is the key to improve outcomes of this frequently lethal disease and is the main target of current researches.

Financial Disclosure:

None