View abstract

This abstract is assigned to sessions

Presentation type	E-poster
Title	Paradoxical Worsening of Hypopyon Despite Clinical Improvement in Fusarium Keratitis: A Case Report

Purpose	To describe a paradoxical increase in hypopyon despite progressive improvement of corneal ulceration and infiltration in a patient with suspected filamentous fungal keratitis.
Methods	A patient with severe corneal ulceration and infiltration at the main incision site following cataract surgery complicated by chronic wound leakage was followed clinically. Serial clinical examinations, microbiological findings, treatment response and visual acuity were documented.
Results	Corneal scraping grew Staphylococcus aureus, susceptible to tobramycin and vancomycin; fungal cultures remained negative. Treatment with topical tobramycin, vancomycin, amphotericin B and voriconazole was initiated. After seven days without significant improvement of the corneal ulcer or infiltration, topical natamycin was started due to suspected filamentous fungal infection. Following days, the hypopyon increased despite progressive reduction of the corneal infiltration, creating a diagnostic dilemma between persistent infection and a paradoxical inflammatory response. Natamycin was continued without adding any other therapy. The hypopyon increased over several subsequent examinations before gradually decreasing and resolving completely after approximately 20 days. Visual acuity improved from counting fingers at 1.5 m to 0.2.
Conclusion	An increasing hypopyon may not necessarily indicate progression of corneal ulceration or infection. Discordance between worsening anterior chamber inflammation and improving corneal infiltration may suggest a paradoxical inflammatory response. Recognition of this phenomenon may help prevent misinterpretation of clinical deterioration and unnecessary changes in antimicrobial therapy.
Conflict of interest	No

Authors 1

Last name	ATALAY
Initials	G
Department	Antwerp University Hospital (UZA)
City	Antwerp

Authors 2

Last name	Koppen
Initials	C
Department	Antwerp University Hospital (UZA)
City	Antwerp