Bilateral Curvularia Keratitis

A 45-year-old female presented with bilateral ocular pain and redness. The best-corrected visual acuity (BCVA) at presentation was 20/30 OD and 20/100 OS. Slit lamp examination revealed 2×2 mm epithelial defects with mid-stromal infiltrate and dark brown corneal plaques on both eyes. The plaque surface was dry and raised with brownish pigmentation. The margins of the stromal infiltrate had feathery edges. Corneal scraping was performed bilaterally. The Sabouraud’s dextrose agar culture of each eye grew woolly, gray to black colonies by the seventh day. A Curvularia sp. was identified. The patient was treated with intensive medical treatment, including topical natamycin suspension (5%) applied every half hour OU for five days along with cycloplegics. Antifungal therapy was decreased to every 2 hours for seven days. Response to medical treatment alone was favorable, with significant improvement in BCVA. A 12- day follow-up examination revealed a faint paracentral scar in the right eye and central corneal opacity in the left eye, but both ulcers had resolved completely. The final BCVA upon follow-up was 20/20 OD and 20/80 OS.