Keratomycosis due to Tintelnotia destructans refractory to common therapy treated successfully with systemic and local terbinafine in combination with polyhexamethylene biguanide

Purpose To report on a wearer of rigid gas-permeable contact lenses with a keratomycosis due to Tintelnotia —a new genus of Phaeosphaeriaceae —treated with terbinafine and polyhexamethylene biguanide. Methods Chart review of a patient with fungal keratitis treated additionally with systemic and topical terbinafine 0.25% after symptoms increased under conventional antimycotic therapy with voriconazole. Antifungal susceptibility had been tested in vitro. Results After starting an additional treatment with systemic and topical terbinafine, the severe corneal infection was sufficiently resolved. The drug was well tolerated without any neurological, dermatological or gastroenterological problems. Terbinafine revealed a marked in vitro antifungal activity of 0.12 µg/ml. The fungus was identified as Tintelnotia destructans. Conclusions Terbinafine might be considered as a therapeutic option in severe cases of fungal keratitis refractory to common antifungal therapy.