{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T17:29:39Z","timestamp":1778261379162,"version":"3.51.4"},"reference-count":11,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,5,19]],"date-time":"2021-05-19T00:00:00Z","timestamp":1621382400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,5,19]],"date-time":"2021-05-19T00:00:00Z","timestamp":1621382400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Ophthalmol"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Filamentous fungi are ubiquitous in plants, water, and soil. The predominant fungi that infect the human cornea include <jats:italic>Fusarium<\/jats:italic> and <jats:italic>Aspergillus<\/jats:italic> species. The onset of fungal endophthalmitis is indolent, and typically takes weeks to months to develop after corneal infection. We report a case of <jats:italic>Fusarium<\/jats:italic> infection complicating rheumatic keratitis that acutely progressed to endophthalmitis during intravenous tocilizumab therapy.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Case presentation<\/jats:title>\n                <jats:p>A 65-year-old female patient was referred to our department due to pain and decreased vision in her left eye. Slit-lamp examination showed a white focus on the upper peripheral cornea, hypopyon, anterior chamber fibrin formation, marked ciliary hyperemia, and whole corneal epithelial defects. As the corneal scraping smear was positive for filamentous fungi and <jats:italic>Fusarium<\/jats:italic> species were detected by aqueous humor polymerase chain reaction, anti-fungal therapy was started. Although the initial response to anti-fungal therapy was good, we observed corneal infiltration, worsening hypopyon, and vitreous opacity after tocilizumab infusion. Given that the infection continued to progress despite conservative therapy, we performed penetrating keratoplasty combined with vitrectomy. After removal of the white focus beneath the intraocular lens, a temporary corneal prosthesis was mounted and the dense vitreous opacity was removed. Finally, a frozen donor graft was sutured in place. The corneal infiltration, hypopyon, and vitreous opacity all disappeared after the operation.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>The rapid progression of <jats:italic>Fusarium<\/jats:italic> keratitis to endophthalmitis in a patient who was receiving a regular infusion of tocilizumab demonstrates that ocular condition should be closely monitored during systemic tocilizumab administration due to increased risk of infection.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12886-021-01981-9","type":"journal-article","created":{"date-parts":[[2021,5,19]],"date-time":"2021-05-19T13:09:23Z","timestamp":1621429763000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Fusarium infection complicating rheumatic keratitis that acutely progressed to endophthalmitis during regular infusion of tocilizumab: a case report"],"prefix":"10.1186","volume":"21","author":[{"given":"Yusuke","family":"Mitsuoka","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0985-530X","authenticated-orcid":false,"given":"Takeshi","family":"Soma","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kazuichi","family":"Maruyama","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kohji","family":"Nishida","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2021,5,19]]},"reference":[{"issue":"2","key":"1981_CR1","doi-asserted-by":"publisher","first-page":"257","DOI":"10.1016\/j.ajo.2014.10.027","volume":"159","author":"RA Silva","year":"2015","unstructured":"Silva RA, Sridhar J, Miller D, Wykoff CC, Flynn HW Jr. Exogenous fungal endophthalmitis: an analysis of isolates and susceptibilities to antifungal agents over a 20-year period (1990-2010). Am J Ophthalmol. 2015;159(2):257\u201364. https:\/\/doi.org\/10.1016\/j.ajo.2014.10.027.","journal-title":"Am J Ophthalmol"},{"issue":"7","key":"1981_CR2","doi-asserted-by":"publisher","first-page":"941","DOI":"10.1001\/archopht.124.7.ecs60039","volume":"124","author":"EC Alfonso","year":"2006","unstructured":"Alfonso EC, Cantu-Dibildox J, Munir WM, Miller D, O\u2019Brien TP, Karp CL, et al. Insurgence of Fusarium keratitis associated with contact lens wear. Arch Ophthalmol. 2006;124(7):941\u20137. https:\/\/doi.org\/10.1001\/archopht.124.7.ecs60039.","journal-title":"Arch Ophthalmol"},{"key":"1981_CR3","doi-asserted-by":"publisher","first-page":"110","DOI":"10.1086\/430062","volume":"40","author":"RR Klont","year":"2005","unstructured":"Klont RR, Eggink CA, Rijs AJMM. Wesseling P, Verweij. Successful treatment of Fusarium keratitis with cornea transplantation and topical and systemic voriconazole. 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J Infect Chemother. 2018;24(2):138\u201341. https:\/\/doi.org\/10.1016\/j.jiac.2017.09.009.","journal-title":"J Infect Chemother"},{"issue":"3","key":"1981_CR10","doi-asserted-by":"publisher","first-page":"222","DOI":"10.3109\/s10165-010-0279-5","volume":"20","author":"N Nishimoto","year":"2010","unstructured":"Nishimoto N, Ito K, Takagi N. Safety and efficacy profiles of tocilizumab monotherapy in Japanese patients with rheumatoid arthritis: meta-analysis of six initial trials and five long-term extensions. Mod Rheumatol. 2010;20(3):222\u201332. https:\/\/doi.org\/10.3109\/s10165-010-0279-5.","journal-title":"Mod Rheumatol"},{"issue":"1","key":"1981_CR11","doi-asserted-by":"publisher","first-page":"15","DOI":"10.3899\/jrheum.130466","volume":"41","author":"T Koike","year":"2014","unstructured":"Koike T, Harigai M, Inokuma S, Ishiguro N, Ryu J, Takeuchi T, et al. Effectiveness and safety of tocilizumab: postmarketing surveillance of 7901 patients with rheumatoid arthritis in Japan. 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Written informed consent was obtained from the participant.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the editor of this journal.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"KM is a member of the editorial board of this journal.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"224"}}