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 Table of Contents  
OPHTHALMIC IMAGES
Year : 2020  |  Volume : 58  |  Issue : 3  |  Page : 218-219

Dragon plaque – natamycin drug deposit masquerading as fungal infiltrate


Cataract, Cornea and Refractive Services, Aravind Eye Hospital, Puducherry, India

Date of Submission17-Apr-2020
Date of Decision14-May-2020
Date of Acceptance29-May-2020
Date of Web Publication14-Sep-2020

Correspondence Address:
Dr. Kirandeep Kaur
Fellow Pediatric and Squint Services, Aravind Eye Hospital, Puducherry
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/tjosr.tjosr_40_20

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How to cite this article:
Gurnani B, Kaur K, Christy J, Narayana S. Dragon plaque – natamycin drug deposit masquerading as fungal infiltrate. TNOA J Ophthalmic Sci Res 2020;58:218-9

How to cite this URL:
Gurnani B, Kaur K, Christy J, Narayana S. Dragon plaque – natamycin drug deposit masquerading as fungal infiltrate. TNOA J Ophthalmic Sci Res [serial online] 2020 [cited 2020 Oct 20];58:218-9. Available from: https://www.tnoajosr.com/text.asp?2020/58/3/218/294989



A 50-year-old male presented with sugarcane leaf injury in the right eye (OD) 2 months back. Best-corrected visual acuity in OD was hand moments, and the left eye (OS) was 20/20. Ocular examination in OD revealed circumcorneal congestion, central anterior feathery stromal infiltrate, stromal edema, Descemet membrane folds, satellite lesions, trace hypopyon with clear lens [Figure 1]. Corneal scraping revealed fungal filaments on Gram and KOH stain. Patients were treated with antifungals for 2 months. The corneal infiltrate showed excellent resolution. On the last review, ocular examination revealed natamycin plaque [Figure 2] over the cornea masquerading as residual fungal infiltrate. Natamycin is a tetraene polyene which has been regarded as the most important agent in the management of fungal keratitis.[1] Chronic long-term administration of natamycin can lead to the formation of plaque over the corneal surface, which can masquerade as infiltrate.[2],[3]
Figure 1: Image of the right eye of the patient depicting circumcorneal congestion, central anterior feathery stromal infiltrate, stromal edema, Descemet membrane folds, satellite lesions, trace hypopyon with clear lens

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Figure 2: Image of the right eye of the patient posttreatment depicting natamycin plaque over the cornea masquerading as residual fungal infiltrate

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Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given his consent for his images and other clinical information to be reported in the journal. The patient understands that his name and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Arora R, Gupta D, Goyal J, Kaur R. Voriconazole versus natamycin as primary treatment in fungal corneal ulcers. Clin Exp Ophthalmol 2011;39:434-40.  Back to cited text no. 1
    
2.
Prajna NV, Krishnan T, Mascarenhas J, Rajaraman R, Prajna L, Srinivasan M, et al. The mycotic ulcer treatment trial: A randomized trial comparing natamycin vs voriconazole. JAMA Ophthalmol 2013;131:422-9.  Back to cited text no. 2
    
3.
Wang DM, Chen GS, Huang MH. Observation of therapeutical effect of natamycin in fungal corneal ulcer. Guoji Yanke Zazhi (Int Eye Sci) 2010;10:744-5.  Back to cited text no. 3
    


    Figures

  [Figure 1], [Figure 2]



 

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