---
title: "Pythium keratitis case report: diagnosis, linezolid therapy, and surgical outcomes"
id: "pubmed-42855783"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42855783"
content_type: "clinical_feed_article"
specialty: "Pharmacology"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42855783/"
doi: "10.3760/cma.j.cn112142-20251022-00438"
published_at: "2026-10-11T00:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Pythium keratitis case report: diagnosis, linezolid therapy, and surgical outcomes
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42855783
- **Specialty:** [Pharmacology](https://medichelpline.com/clinical-feed/pharmacology.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42855783/)
- **DOI:** [10.3760/cma.j.cn112142-20251022-00438](https://doi.org/10.3760%2Fcma.j.cn112142-20251022-00438)
- **Published At:** 2026-10-11T00:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- A 31-year-old woman developed right-eye redness, pain, photophobia and vision loss over 3 weeks after exposure to tap water. Slit-lamp exam showed corneal lesions with **pseudopodia** and hill-shaped hypopyon. - **In vivo confocal microscopy** (IVCM) identified filament-like structures in the corneal stroma, prompting an initial clinical diagnosis of fungal keratitis. - Standard antifungal therapy was started but the corneal infection progressed despite treatment. - Repeat corneal scrapings with culture and **targeted DNA sequencing** identified **Pythium insidiosum** as the causative organism. - Recognizing that **Pythium** are oomycetes intrinsically resistant to conventional antifungals but susceptible to some antibacterial agents, therapy was changed to a **linezolid**-based antibacterial regimen. - Despite antimicrobial change, the patient developed corneal perforation and underwent total keratoplasty with a scleral ring. - Infection recurred two weeks postoperatively; multiple **intracameral and intrastromal injections of linezolid** were administered, which controlled the relapse. - A secondary penetrating keratoplasty was performed; at 11-month follow-up there was no recurrence, the graft remained transparent, and best corrected visual acuity improved to 0.6. - The case underscores that early **targeted DNA sequencing** is essential when suspected fungal keratitis fails to respond to antifungals, and that prompt use of sensitive antibacterials plus individualized surgical intervention are critical to control **Pythium keratitis** and optimize visual outcome.
## Clinical Analysis & Structured Key Points
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Affiliations Expand ### Affiliation * 1 State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University; Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science; Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou 510060, China. * PMID: **42855783** * DOI: [ 10.3760/cma.j.cn112142-20251022-00438 ](https://doi.org/10.3760/cma.j.cn112142-20251022-00438) Item in Clipboard Case Reports # [Pythium keratitis: a case report] [Article in Chinese] M Xuan et al. Zhonghua Yan Ke Za Zhi. 2026. Show details Display options Display options Format Abstract PubMed PMID Zhonghua Yan Ke Za Zhi Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Zhonghua+Yan+Ke+Za+Zhi%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22Zhonghua+Yan+Ke+Za+Zhi%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42855783/) . 2026 Oct 11;62(10):855-860. doi: 10.3760/cma.j.cn112142-20251022-00438. ### Authors [M Xuan](https://pubmed.ncbi.nlm.nih.gov/?term=Xuan+M&cauthor_id=42855783)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42855783/#short-view-affiliation-1 "State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University; Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science; Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou 510060, China."), [B Y Yang](https://pubmed.ncbi.nlm.nih.gov/?term=Yang+BY&cauthor_id=42855783)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42855783/#short-view-affiliation-1 "State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University; Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science; Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou 510060, China."), [L Y Liang](https://pubmed.ncbi.nlm.nih.gov/?term=Liang+LY&cauthor_id=42855783)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42855783/#short-view-affiliation-1 "State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University; Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science; Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou 510060, China.") ### Affiliation * 1 State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University; Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science; Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou 510060, China. * PMID: **42855783** * DOI: [ 10.3760/cma.j.cn112142-20251022-00438 ](https://doi.org/10.3760/cma.j.cn112142-20251022-00438) Item in Clipboard Cite Display options Display options Format Abstract PubMed PMID Linked Discoveries ## Abstract in [ English, ](https://pubmed.ncbi.nlm.nih.gov/42855783/#eng-abstract) [ Chinese ](https://pubmed.ncbi.nlm.nih.gov/42855783/#zho-abstract) A 31-year-old female presented with a 3-week history of right eye redness, ocular pain, photophobia and decreased vision after tap water exposure. Slit-lamp examination revealed corneal lesions with pseudopodia and hill-shaped hypopyon. _In vivo_ confocal microscopy (IVCM) detected filament-like structures in the corneal stroma. The patient was initially suspected of having fungal keratitis, but the condition deteriorated despite standardized antifungal treatment. Repeated corneal scraping culture and targeted DNA sequencing confirmed the infection of _Pythium insidiosum_. After switching to linezolid-based antibacterial therapy, corneal perforation still occurred, and total keratoplasty with a scleral ring was performed. The infection relapsed at 2 weeks postoperatively and was finally controlled by multiple intracameral and intrastromal injections of linezolid. A secondary penetrating keratoplasty was subsequently performed. No recurrence was observed during the 11-month follow-up; the corneal graft remained transparent, and the best corrected visual acuity improved to 0.6. _Pythium_ species are oomycetes instead of true fungi, which are intrinsically resistant to conventional antifungal agents but susceptible to specific antibacterial drugs such as linezolid. For clinically suspected Pythium keratitis unresponsive to antifungal treatment, early targeted DNA sequencing is essential for rapid pathogen identification. Timely administration of sensitive antibacterial agents and individualized surgical intervention are critical to control infection and optimize visual prognosis. 31岁女性患者接触自来水后出现右眼红痛、畏光及视力下降3周。裂隙灯检查可见角膜病灶伪足和山丘状积脓，角膜活体共聚焦显微镜查见菌丝样结构，临床拟诊真菌性角膜炎，予抗真菌治疗无效。再次角膜刮取物培养及靶向DNA测序确诊为谲诈腐霉菌感染，改用利奈唑胺等抗菌药物治疗后仍发生角膜穿孔，遂行带巩膜环全角膜移植术。术后2周感染复发，予多次前房及角膜基质内注射利奈唑胺后感染控制，二期行穿透性角膜移植术。随访11个月感染无复发，角膜植片透明，最佳矫正视力0.6。本病例提示，腐霉菌属卵菌而非真菌，对常规抗真菌药物天然耐药，对利奈唑胺等抗菌药物敏感；对抗真菌治疗无效的疑似腐霉菌性角膜炎，应尽早行靶向DNA测序快速明确病原体，确诊后及时选用敏感抗菌药物并适时手术干预。. [PubMed Disclaimer](https://pubmed.ncbi.nlm.nih.gov/disclaimer/) ## Conflict of interest statement 所有作者声明不存在利益冲突 ## Similar articles * [ Successful management of pediatric pythium insidiosum keratitis with cyanoacrylate glue, linezolid, and azithromycin: Rare case report. ](https://pubmed.ncbi.nlm.nih.gov/33779337/) Gurnani B, Narayana S, Christy J, Rajkumar P, Kaur K, Gubert J.Gurnani B, et al.Eur J Ophthalmol. 2022 Sep;32(5):NP87-NP91. doi: 10.1177/11206721211006564. Epub 2021 Mar 28.Eur J Ophthalmol. 2022.PMID: 33779337 * [ Case Series: Mixed Infectious Keratitis by Pythium insidiosum and Fungal Species. ](https://pubmed.ncbi.nlm.nih.gov/38019963/) Singh NK, Barik MR, Das S, Sahu SK, Priyadarshini SR, Sharma S, Sahu SS, Behera HS.Singh NK, et al.Optom Vis Sci. 2023 Dec 1;100(12):887-894. doi: 10.1097/OPX.0000000000002092. Epub 2023 Nov 27.Optom Vis Sci. 2023.PMID: 38019963 * [ Outbreak of Pythium keratitis during rainy season: a case series. ](https://pubmed.ncbi.nlm.nih.gov/22902492/) Thanathanee O, Enkvetchakul O, Rangsin R, Waraasawapati S, Samerpitak K, Suwan-apichon O.Thanathanee O, et al.Cornea. 2013 Feb;32(2):199-204. doi: 10.1097/ICO.0b013e3182535841.Cornea. 2013.PMID: 22902492 * [ Diagnosis and Treatment of Pythium Insidiosum Corneal Ulcer in a Chinese Child: A Case Report and Literature Review. ](https://pubmed.ncbi.nlm.nih.gov/28025573/) He H, Liu H, Chen X, Wu J, He M, Zhong X.He H, et al.Am J Case Rep. 2016 Dec 27;17:982-988. doi: 10.12659/ajcr.901158.Am J Case Rep. 2016.PMID: 28025573Free PMC article.Review. * [ Advancing diagnostics in Pythium insidiosum keratitis: the emerging role of point-of-care imaging and biosensor-based detection devices. ](https://pubmed.ncbi.nlm.nih.gov/41147335/) Gurnani B, Kaur K.Gurnani B, et al.Expert Rev Med Devices. 2025 Dec;22(12):1287-1292. doi: 10.1080/17434440.2025.2582616. Epub 2025 Nov 2.Expert Rev Med Devices. 2025.PMID: 41147335Review. 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