Simultaneous bilateral Candida tropicalis keratitis in an HIV-positive patient

A man in his late forties, who has been on antiretroviral therapy, was treated elsewhere for toxic keratitis for 1 month. On presentation, BE had severe meibomitis, reduced tear meniscus, and corneal epithelial defects with multiple, raised, breadcrumb-like pinhead-sized chalky white infiltrates. Microbiological examination of corneal scrapings from BE showed budding yeast cells with pseudo hyphae and growth of Candida tropicalis . The organism was susceptible to voriconazole and amphotericin-B. Considering toxicity of amphotericin-B on the ocular surface, voriconazole was started hourly, to which response was noted. This case highlights the importance of comanagement of dry eye and infection in HIV patients.