Ocular infection with Gliocladium species—report of a case
© The Author(s). 2017
Received: 24 January 2017
Accepted: 10 March 2017
Published: 14 March 2017
The purpose of this study is to report a case of ocular infection with Gliocladium species due to an exposed scleral buckle.
Interventional case report was used as the study design.
A 60-year-old diabetic male patient presented with persistent pain, redness, and discharge in his left eye since 2 months. He had been treated previously with both topical and systemic steroids for a diagnosis of autoimmune scleritis. He had undergone scleral buckling surgery with cryotherapy for an inferior rhegmatogenous retinal detachment in the past. His best-corrected visual acuity was 6/6, N6 and 6/6, N6 in the right and left eyes, respectively. Retraction of the left lower lid revealed an exposed scleral buckle with an overlying necrotic conjunctiva. Scleral buckle removal was done. Microbiological examination showed Gliocladium species growing on blood agar and Sabouraud dextrose agar. Treatment was started with topical antifungal medication and oral antibiotics.
Following treatment, signs of infection showed resolution. Patient underwent retinal reattachment surgery with favorable anatomic and visual outcome.
Ocular infection with Gliocladium species has not been previously reported. Poor response to steroids and uncontrolled diabetes should make the clinician aware of a possible fungal infection. Removal of the scleral buckle, identification of the causative organism, and use of appropriate antibiotics are important for the accurate management of the case.
KeywordsBuckle infection Gliocladium species Fungus
In the current era, scleral buckling with explants still remains an important and effective technique to attach the retina. Extrusion and infection of the scleral buckle (SB) are the two most common indications for SB removal . Many organisms, generally bacteria, have been implicated as a cause of SB infection. Fungus as a cause of SB infection is rare. We report a case of ocular infection in an old diabetic man caused by a rare fungus called Gliocladium species due to an exposed SB. This happens to be the first reported case of ocular infection due to Gliocladium species in literature to the best of our knowledge.
SB infection and extrusion remain fairly uncommon complications following scleral buckling surgery. Their estimated incidence varies from 0.2 to 5.6% [2–6]. Coagulase-positive and coagulase-negative Staphylococci are implicated as the most common organisms causing SB infection (70 to 90% of cases) . However, rarer cases with infections due to atypical mycobacterium, corynebacteria, and fungi have been reported . In a series of 132 cases of SB infections studied by Chhablani et al. , only 15 cases were caused by fungi. The most common fungus isolated in their series was the Aspergillus species. Our patient was an elderly diabetic male, misdiagnosed as autoimmune scleritis, and treated extensively with topical and oral corticosteroids. Careful examination revealed an exposed SB element with an overlying necrotic conjunctiva. Culture positivity was noted in 5 days. The SB grew Gliocladium species on culture media. Gliocladium is a mitosporic, filamentous fungus. Commonly occurring species include Gliocladium penicilloides, Gliocladium virens, and Gliocladium roseum. Most species of Gliocladium grow rapidly in culture producing spreading colonies with a cotton-like texture, covering a petri dish in 1 week. The colonies are initially white and cream-like but may become reddish or green as they age and sporulate. Microscopically, Gliocladium species produces hyphae, conidiophores, and conidia borne from hyaline phialides. The conidiophores are erect, dense, and have a brush-like structure which produces tapering, slimy phialides . Gliocladium species is a saprophytic fungus. The necrotic conjunctiva and scleral tissue provides an excellent environment for the organism to grow. In our case, following the growth of this rare fungus, we rightly modified our treatment by adding topical voriconazole to the regime.
To the best of our knowledge, this is the first case report of ocular infection with Gliocladium species. Poor response to steroids and uncontrolled diabetes should make the clinician aware of a possible fungal infection. Removal of the SB, identification of the causative organism, and use of appropriate antibiotics are vital for the accurate management of the case.
Best-corrected visual acuity
Sabouraud dextrose agar
Availability of data and materials
All the data and images pertaining to the case are available with the corresponding author.
RV drafted the manuscript and critically reviewed the manuscript; PG worked on the acquisition of the data; MAA carried out the management of the case and reviewed the manuscript; NS did the reporting of the microbiological aspect of the case; and PAD made the review of the literature and reviewed the manuscript. All authors read and approved the final manuscript.
The authors declare that they have no competing interests.
Consent for publication
Written informed consent was obtained from the patient for the publication of this report and any accompanying images. Approval was granted to us by our own institute’s IRB.
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