Infection of lacrimal gland by high infectious fungus - differentiated considerations

In rare cases, inflammation of the lacrimal glands is caused by fungi. We report a mycotic dacryocystitis caused by Arthrographis kalrae. This pathogen is a filamentous, rarely human pathogenic ascomycetous fungus that occurs worldwide and is responsible for skin and nail infections in humans. Infections caused by this pathogen are occasionally resistant to standard antifungal drugs. If left untreated, serious complications can result, like is documented in the literature with cases of maxillary and ethmoid sinusitis with accompanying loss of vision.

A 79-year-old patient presented to our clinic with a swelling in the area of ​​the right lacrimal sac with accompanying epiphora. The primary suspected diagnosis was acute bacterial dacryocystitis. Therefore a topical and intravenous antibiotic therapy was initiated and an incision of the abscess was executed in the area of ​​the right corner of the eye. This resulted a reduction of symptoms. The microbiological finding test showed a growth of A. kalrae. Immunosuppression, gardening or contact with earth, animals and trauma in this area were denied. According to the antimycogram, intravenous therapy with voriconazole was carried out, followed by oral therapy for 4 weeks. The microbiological controls showed no evidence of A. kalrae.

In the case of therapy refractory inflammation, the differential diagnostic possibility of a fungal infection should always be considered. In highly pathogenic agents, consistent therapy must take place.

 

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Conflict of Interest

The author declares that there is no conflict of interest.

Publication History

Article published online:
24 May 2022