First case of Kluyveromyces marxianus (Candida kefyr) late onset keratitis after lamellar endothelial corneal graft

Alexander M Aldejohann; Johanna Theuersbacher; Lukas Haug; Olga S Lamm; Grit Walther; Oliver Kurzai; Jost Hillenkamp; Daniel Kampik

doi:10.1016/j.mmcr.2021.02.001

First case of Kluyveromyces marxianus (Candida kefyr) late onset keratitis after lamellar endothelial corneal graft

Med Mycol Case Rep. 2021 Feb 12:32:21-24. doi: 10.1016/j.mmcr.2021.02.001. eCollection 2021 Jun.

Authors

Alexander M Aldejohann¹, Johanna Theuersbacher², Lukas Haug³, Olga S Lamm², Grit Walther⁴, Oliver Kurzai^{1

4}, Jost Hillenkamp², Daniel Kampik²

Affiliations

¹ Julius-Maximilians-University, Institute for Hygiene and Microbiology, Josef-Schneider- Str.2, 97080, Würzburg, Germany.
² University Hospital of Würzburg, Department of Ophthalmology, Josef- Schneider-Str. 11, 97080, Würzburg, Germany.
³ Julius-Maximilians-University, Institute of Pathology, Josef-Schneider-Str. 2, 97080, Würzburg, Germany.
⁴ National Reference Center for Invasive Fungal Infections NRZMyk, Leibniz Institute for Natural Product Research and Infection Biology - Hans Knöll Institute (HKI), Adolf-Reichwein-Str. 23, 07745, Jena, Germany.

Abstract

We present a case of Kluyveromyces marxianus keratitis nine months after Descement's membrane endothelial keratoplasty (DMEK) in a patient with Fuchs endothelial disease. Endothelial scraping revealed this rare yeast infection at the interface between graft and host cornea. Immediate antifungal treatment with intracameral and corneal intrastromal injections of voriconazole and amphotericin B remained unsuccessful, requiring penetrating keratoplasty. This case highlights the challenging management of keratomycosis in patients with endothelial grafts.

Keywords: Amphotericin B; Corneal transplantation; DMEK; Fungal keratits; Kluyveromyces marxianus (Candida kefyr); Voriconazole.

Publication types

Case Reports