Ocular and systemic posaconazole(SCH-56592) treatment of invasive Fusarium solani keratitis and endophthalmitis
- W E Sponsel1,
- J R Graybill2,
- H L Nevarez3,
- D Dang4
- 1Department of Ophthalmology, University of Texas Health Science Center, San Antonio, Texas, USA
- 2Division of Infectious Diseases in the Department of Medicine
- 3Vista Eye Associates
- 4Department of Ophthalmology, University of Texas Health Science Center
- Correspondence to: William Sponsel, Director of Clinical Research, Ophthalmology, 7703 Floyd Curl Drive, San Antonio, TX 78229–3900, USA; sponsel{at}uthscsa.edu
- Accepted 8 February 2002
An emmetropic 42 year old immunocompetent woman with 6/6 vision developed left eye pain while wearing cosmetic soft contact lenses. She presented on 28 July 2000 to her ophthalmologist, who noted deep stromal infiltration accompanying a 2 × 3 mm pericentral corneal ulcer. Cultures yielded Staphylococcus aureus, Streptococcus viridans, and Fusarium solani. Initial therapy with tobramycin was followed by high dose topical hydroquinolones, whereafter the infection, continuing unabated, was construed to be fungal keratitis. High doses of amphotericin B both topical and intravenously, natamycin, and ketoconazole were administered, along with topical fortified cephazolin, neosporin, and atropine. Despite these, the lesion spread to involve much of the corneal periphery (Fig 1), and repeat corneal cultures confirmed the presence of amphotericin B resistant Fusarium spp (MIC 24:48 hours in μg/ml: amphotericin B 2:2; natamycin 32:32; posaconazole 1:8).
On 1 September 2000, the anterior chamber was filled with fibrin with a central corneal descemetocele and near total corneal infiltration, affording …
