Mycotic keratitis caused by Bipolaris species - Report of two cases

Nonocular Bipolaris infection usually occurs in immunocompromised patients. Corneal infections with Bipolaris have rarely been reported. A review of the literature shows that corneal infections caused by Bipolaris species occurred mainly in immunocompetent hosts. Here, we report two cases of Bipolaris keratitis refractory to medical treatment. Case 1, a 64-year-old man, had liver cirrhosis and hepatoma associated with systemic immunocompromization. The keratitis presented with an elevated plaque in the peripheral cornea. The lesion responded poorly to antifungal agents. Initially, after vigorous debridement of the plaque, there was some clinical improvement. However, the patient also had a superimposed pseudomonal infection. He was treated with antifungal and antibacterial medication, and the lesion responded successfully with the sequela of corneal leukoma. Case 2, a 41-year-old female, had facial palsy with lagophthalmos. A central corneal ulcer with necrotizing pattern and hypopyon was noted. Despite intensive treatment with antifungal agents for 2 weeks, there was no evidence of improvement. A therapeutic penetrating keratoplasty was done due to uncontrollable infection. Following these treatment modalities, she preserved ocular integrity and had useful vision.