Voriconazole used for rare Scedosporium aurantiacum keratitis in a single 80-year-old patientRare Fungal Eye Infection Treated With Voriconazole in 80-Year-Old

Scedosporium aurantiacum is a fungus that is commonly present in the environment of Australia and Japan but has also been reported from some European regions. The diagnosis of scedosporiosis is dependent on culture despite its slow growth, with the subsequent identification using MALDI-TOF MS or sequencing of the specific genomic region. This study describes a very rare case of the infectious keratitis caused by S. aurantiacum and probably the first such case reported in Europe. The patient was an 80-year-old woman, referred to the Ophthalmology Department of the University Hospital in Hradec Kralove with a painful corneal ulcer of her right eye, which was deteriorating despite a previous topical and oral antibiotic treatment elsewhere. Her medical history included unspecified bilateral lacrimal drainage system surgery and a partial lateral tarsorrhaphy of her right eyelids due to a keratitis caused by lagophthalmos. Three days after severing of the tarsorrhaphy, ocular pain appeared and corneal ulcer developed, accompanied by progressive inflammation in the anterior chamber. A microbiological culture analysis of conjunctival swabs and corneal scraping yielded colonies of filamentous fungi, which was subsequently identified by MALDI-TOF MS as Scedosporium aurantiacum with a score consistent with species-level identification. Based on these findings, treatment with topical and oral voriconazole was initiated. Ocular infections caused by S. aurantiacum are extremely rare, but this species appears to be an emerging pathogen for infectious keratitis. To date, only three similar cases have been reported and well described worldwide. The infection is often indistinguishable from other fungal infections, and the therapy depends on the speedy identification of fungal species and its susceptibility to antifungals.