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Favorable outcome of Lasiodiplodia theobromae keratomycosis: a clinical case and systematic review

Summary

A 74-year-old farmer developed a serious fungal eye infection caused by Lasiodiplodia theobromae, a rare tropical fungus. Instead of requiring eye surgery, the patient was successfully treated with a combination of two antifungal medications applied as eye drops and taken orally for eight weeks. This case is significant because it’s the first documented successful medical treatment of this particular fungal infection, highlighting the importance of quick diagnosis and avoiding corticosteroid eye drops that can worsen fungal infections.

Background

Fungal keratitis caused by Lasiodiplodia theobromae is rare and typically associated with poor prognosis. Only 68 ocular infection cases have been recorded in literature since first description in 1967, with mostly unfavorable outcomes. Current literature lacks sufficient evidence on effective management protocols for this condition.

Objective

To present a case of Lasiodiplodia theobromae keratitis with favorable outcome treated with combined natamycin and voriconazole therapy and to conduct a systematic review of all previously published cases of this fungal infection.

Results

Patient achieved visual acuity of 20/50 after eight weeks of combined antifungal treatment without surgical intervention or corticosteroid use. Systematic review identified 68 total ocular infection cases (65 keratitis and 3 endophthalmitis). Only 7 of 30 patients with documented management achieved successful medical treatment without surgery, with rapid initiation of antifungal therapy being crucial.

Conclusion

This case represents the first documented favorable outcome of Lasiodiplodia theobromae keratitis using combined natamycin and voriconazole therapy without prior corticosteroid administration. Rapid diagnosis and prompt antifungal treatment initiation significantly contribute to favorable outcomes. Further robust studies are needed to validate this treatment approach despite the rarity of the infection.
  • Published in:BMC Ophthalmology,
  • Study Type:Case Report with Systematic Review,
  • Source: PMID: 39118115, DOI: 10.1186/s12886-024-03599-z
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