27 December 2016
: Case report
Diagnosis and Treatment of Pythium Insidiosum Corneal Ulcer in a Chinese Child: A Case Report and Literature Review
Diagnostic / therapeutic accidents, Unusual setting of medical care, Rare disease, Educational Purpose (only if useful for a systematic review or synthesis)
Hong He1ABCDEFG, Hongshan Liu1ABC, Xiaolian Chen1CD, Jiaochan Wu1BC, Miao He2B, Xingwu Zhong12ABCG*DOI: 10.12659/AJCR.901158
Am J Case Rep 2016; 17:982-988
Abstract
BACKGROUND: Pythium insidiosum keratitis is a rare but sight-threatening disease with a high morbidity rate. It can be misdiagnosed as fungal keratitis in clinic settings. We report a case of severe Pythium insidiosum keratitis in a Chinese child, treated with combined approaches.
CASE REPORT: A 7-year-old boy from Hainan province in the south of China developed a suppurative corneal ulcer after being in a forest. A mass of hyphae was detected by confocal imaging in vivo, fungal smear test, and histochemical examination. Treatment with Natamycin, fluconazole, and Voriconazole for 1 month was unsuccessful, and a penetrating keratoplasty with anterior vitrectomy was performed. The infection reappeared 1 day after surgery, immediately after which anterior chamber irrigation with 0.02% Fluconazole and amphotericin B solution was performed. Finally, the globe was saved and there was no further recurrent infection. A cultured mycelial organism, which was hard to identify by biomorphology, was confirmed by PCR to be Pythium insidiosum. The zoospores were observed in water environments. The imaging characteristics of P. insidiosum in confocal microscopy are described herein.
CONCLUSIONS: This is the first case of Pythium insidiosum keratitis reported in China. It can be misdiagnosed as fungal keratitis in the clinic. Improving the awareness of clinicians, promoting early diagnosis, and a multidisciplinary approach, especially early surgery, improve the prognosis.
Keywords: Corneal Ulcer, Microscopy, Confocal, Oomycetes, Pythium
In Press
Case report
Am J Case Rep In Press; DOI: 10.12659/AJCR.945853
Case report
Am J Case Rep In Press; DOI: 10.12659/AJCR.947512
Case report
Am J Case Rep In Press; DOI: 10.12659/AJCR.946691
Case report
Am J Case Rep In Press; DOI: 10.12659/AJCR.946969
Most Viewed Current Articles
21 Jun 2024 : Case report
96,359
DOI :10.12659/AJCR.944371
Am J Case Rep 2024; 25:e944371
07 Mar 2024 : Case report
52,229
DOI :10.12659/AJCR.943133
Am J Case Rep 2024; 25:e943133
20 Nov 2023 : Case report
31,248
DOI :10.12659/AJCR.941424
Am J Case Rep 2023; 24:e941424
18 Feb 2024 : Case report
23,387
DOI :10.12659/AJCR.943030
Am J Case Rep 2024; 25:e943030