We report a case of scleral keratitis caused by Phomopsis phoenicicola. Pterygium surgery was a predisposing factor, and the patient was treated with natamycin and fluconazole eye drops and oral fluconazole. The fungus was identified by sequencing of the internal transcribed spacer (ITS) region of the fungal ribosomal DNA (rDNA) locus and confirmed on the basis of its typical pycnidia and conidia.
CASE REPORTA 48-year-old postman presented with a history of pain, redness, and watering in his right eye since 6 weeks previously. He had undergone pterygium surgery in the same eye 6 weeks ago. The details of the surgical technique and the use of mitomycin C were not available. On examination, his uncorrected visual acuity was just light perception and projection in the right eye and 6/9 in the left eye. Slit lamp examination of the right eye showed a significant area of infiltration (3 to 5 mm) involving the peripheral cornea from the nasal side and extending toward the limbus temporally and superiorly. There was stromal infiltrate surrounding the descemetocele, blood pigments on the endothelium, and a corneal abscess with central thinning. Scleral necrosis and thinning nasally in the area of the pterygium excision were also seen. Diffused stromal haze and significant anterior chamber inflammation with 2-mm hypopyon were evident (Fig. 1A).Corneal scraping material obtained from the infected area was viewed microscopically using a potassium hydroxide (10% KOH)-calcofluor white preparation and Gram staining. It was inoculated on blood agar, potato dextrose agar (PDA), and tryptone soy broth (Himedia Labs Ltd., Mumbai, India) and incubated under appropriate atmospheric conditions. Examination of 10% KOH mounts showed numerous septate and branched hyphae (Fig. 1B).Antifungal treatment was initiated with topical natamycin eye drops (Natamet; 5% suspension; Sun Pharmaceuticals Ind Ltd., Halol, India), moxifloxacin eye drops (Vigamox; 0.5% suspension; Alcon Laboratories Inc., Texas), and fluconazole eye drops (Zocon; 0.3% suspension; FDC Ltd., Aurangabad, India) hourly and atropine eye drops (0.1% suspension; Taj Pharma Ltd., Mumbai, India) three times a day. The patient was also prescribed Iopar tablets (250 mg to reduce intraocular pressure [IOP]) and an antifungal tablet (fluconazole; 150 mg) once daily.The corneal scrapings inoculated onto the PDA and blood agar showed the presence of several colonies of a single fungus within 2 days. Fourteen days later, the lesion improved with a decrease in hypopyon. The natamycin and fluconazole therapy was reduced to every 2 h, and tablet fluconazole was continued. Further improvements were noted, and after 1 month the lesion had healed. The infection subsided in 2 months, following which all the medications were discontinued. The patient was left with a scar on the cornea and a best-corrected vision of 6/12.Mycologic studies. The isolate (ICIRC-CC58) was subcultured on PDA and Sabouraud dextrose agar (SDA) (Himedia Labs Ltd., Mumbai, India) and incubated at 25°C and 37°C. Growth ...