Aspergillus flavus corneal abscess: A case report

Aspergillosis refers to infections caused by fungi of the Aspergillus genus. These cosmopolitan hyalohyphomycetes mainly cause pulmonary infections in predisposed individuals but can also lead to extrapulmonary forms, including ocular involvement. This is a severe condition with a guarded prognosis, requiring appropriate management to prevent potentially blinding complications. We report a case of post-traumatic corneal abscess due to Aspergillus flavus.

A 58-year-old man presented with a painful, red left eye following minor trauma, associated with decreased visual acuity. Initial treatment with antibiotics and corticosteroids was ineffective. Ophthalmologic examination revealed visual acuity limited to hand movements and a central corneal abscess. Mycological examination showed fluffy white colonies at day 2, turning yellow at day 5 and green at day 10, with a brown reverse pigment. Microscopic analysis revealed uniseriate and biseriate aspergillar heads with radiating phialides, a spherical vesicle, a long rough conidiophore, and globose conidia, consistent with Aspergillus flavus. The patient was treated with topical voriconazole followed by intrastromal injection, without improvement, and ultimately required blepharorrhaphy.

Corneal abscess due to Aspergillus flavus represents an ophthalmologic emergency threatening visual prognosis. Its management remains a therapeutic challenge due to diagnostic difficulty and suboptimal response to antifungal therapy. Early diagnosis and appropriate treatment are essential to prevent severe complications.