Multifocal stromal infiltrates or “satellite lesions” have been considered a characteristic feature of fungal keratitis. We examined two patients with nontuberculous mycobacterial keratitis who clinically presented with satellite lesions. The keratitis consisted of multifocal stromal infiltrates with indistinct white and fluffy margins. Both patients received topical fortified amikacin therapy with poor response. Lamellar keratectomy or penetrating keratoplasty was performed, respectively, in the two patients because of progressive stromal thinning and enlarging satellite lesions. Histopathologically, the main lesions consisted of dense infiltration of inflammatory cells with numerous acid-fast bacilli, while the satellite lesions were composed chiefly of inflammatory cells with fewer mycobacteria. Besides fungal keratitis, nontuberculous mycobacterial keratitis should also be considered when satellite lesions are present.
Candidiasis can cause a wide spectrum of clinical syndromes, as described below. The clinical presentation can vary depending on the type of infection and the degree of immunosuppression.
and occasional nail loss.
Chronic mucocutaneous candidiasis
Chronic mucocutaneous candidiasis describes a group of Candida infections of the skin, hair, nails, and mucous membranes that tends to have a protracted and persistent course.
- History: Most infections begin in infancy or during the first 2 decades of life; onset in people older than 30 years is rare.
- Most patients survive for prolonged periods and rarely experience disseminated fungal infections. The most common cause of death is bacterial sepsis.
- Chronic mucocutaneous candidiasis is frequently associated with endocrinopathies, such as the following:
- Addison disease
- Diabetes mellitus
- Autoimmune antibodies to adrenal, thyroid, and gastric tissues (approximately 50%)
- Dental dysplasia
- Polyglandular autoimmune disease
- Antibodies to melanin-producing cells