Nécrose du segment antérieur sur kératomycose à Fusarium polyrésistant

Keratomycosis is a rare sight-threatening infection of the cornea, with greater morbidity than bacterial keratitis. Predisposing factors in its pathogenesis are corneal trauma, mostly of plant origin, and overuse of topical corticosteroids, associated or not with antibiotics. We report a case of a 71-year-old man who developed Fusarium (lichenicola or solani) keratitis, 15 days after beginning topical therapy with a corticosteroid and antibiotic. Despite aggressive antifungal therapy with fluconazole, he required a penetrating keratoplasty for impending corneal perforation, and finally, even after systemic use of itraconazole and topical use of amphotericin B, the infection progressed and an evisceration was required. In the evisceration material, a multidrug-resistant Fusarium lichenicola or solani, was found, partially sensitive to voriconazole only.