Rhodotorula rubra keratitis and melting after repeated penetrating keratoplasty

PURPOSE. To describe a rare case of Rhodotorula rubra keratitis in a corneal graft, and to discuss the management of this unusual pathogen. METHODS. A 78-year-old debilitated man was treated for corneal abscess and descemetocele in his right eye. Urgent penetrating keratoplasty (PKP) with old donor material was performed. The patient underwent a new PKP when appropriate donor cornea was available. The graft was clear after the operation. Corneal cultures were negative. RESULTS. One month after the second PKP procedure, deep stromal infiltrate with hypopyon appeared. Cultures grew R. rubra. A third PKP operation was performed. Systemic and topical amphotericin B treatment was started. Six months after the last operation the graft remains clear. CONCLUSIONS. Rhodotorula keratitis is an extremely rare infection that should be considered in debilitated patients with persistent and progressive corneal infection despite adequate antibiotic therapy.