P166 Traumatic implantation keratitis with Schizophyllum commune in Central India

POSTER SESSION 2, SEPTEMBER 22, 2022, 12:30 PM - 1:30 PM: OBJECTIVES: Documentation and dissemination of findings of difficult-to-treat fungal isolate in cases of Keratitis. METHODS: Both the cases received in 2019 and 2021 were followed and consent from the patient was obtained for documentation. Case 1: A 30-year-old farmer from Raisen, Madhya Pradesh was admitted to AIIMS, Bhopal on December 16, 2019. He presented with eye ache, watering of eyes, and diminution of vision for 15 days. On day0 (D0) December 2, 2019 trauma to the eye by husk, diminution of vision and other symptoms and consulted nearby hospital, and started medication on D06. With symptoms worsening on D14 he was admitted to AIIMS Bhopal. Same day corneal scrapping on KOH mount showed branched septate hyaline hyphae. Culture showed on D20 whitish wooly growth with central pale to pinkish growth. On LBCB mount hyaline septate hyphae with no sporulation and clamp connections observed. Based on whitish growth with raised fanning hairy structures and on microscopy some spicules tear drop like structures and resemblance as clamp connections no other sporulation provisional diagnosis of Schizophyllum species was given. Patient's condition worsened with no response to azoles and therapeutic keratoplasty was done. Case 2: A 56-year-old female sufffered trauma with a leaf. Around D10 was admitted in ophthalmology department of AIIMS, Bhopal with left corneal ulcer and hypopyon. Corneal scrapping was sent but no fungal elements were seen. After 15 days white fluffy growth was observed on SDA with chloramphenicol. On LPCB mount it showed no sporulation and parallel hyphae with clamp connections were observed. Therapeutic keratoplasty was done. Graft failed and condition worsened. No response to intracameral voriconazole. Patient lost vision in both eyes. Case was identified as fungal keratitis with suspected Basidiomycetes Schizophyllum species. Both the isolates were confirmed from PGIMER Reference Center at Chandigarh. RESULT: In both cases surgical intervention was essential but therapeutic keratoplasty failed. CONCLUSION: Recently surge in cases with Schizophyllum commune is observed with difficult management, Failure of therapeutic keratoplasty and infection of graft is a challenge.