Fungal Keratitis Caused by Scedosporium Apiospermum

PURPOSE: We report our experience in treating two cases of Scedosporium apiospermum keratitis and provide a review of basic scientific and clinical data regarding the treatment of this visually devastating disease. METHOD: We present a case report and literature review. RESULTS: A 35-year-old woman and a 73-year-old man both reported pain, redness, and a foreign body sensation in the eye after trauma. They were initially treated with antibacterials. When cultures were positive for S. apiospermum, the first patient was treated with fluconazole and amphotericin with good results. The second was treated with fluconazole and natamycin, but the infection persisted and the eye was eventually enucleated. Review of the literature showed variable responsiveness of S. apiospermum to antifungal treatment. CONCLUSIONS: It is difficult to predict how S. apiospermum keratitis will respond to treatment, but miconazole appears to be useful in conjunction with other antifungals. Voriconazole shows promise as an effective alternative.