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Course: Dematiaceous Fungal Keratitis With Tentacles Mimicking Pythium Keratitis

CME Credits: 1.00

Released: 2023-12-21

A 60-year-old man presented with a corneal infiltrate paracentrally measuring 5?×-5 mm in his right eye with tentacular projections (Figure, A) at the margins, characteristic of Pythium insidiosum keratitis. Corneal scraping showed fungal hyphae on smear examination. On clinical suspicion, the patient was treated with linezolid, 0.2%, and itraconazole, 1%, eye drops as topical linezolid is one of the treatment modalities of choice for Pythium keratitis.1 On follow-up, the patient presented with an increase in pain and deterioration of vision in that eye, along with brownish-black surface pigmentation of the infiltrate (Figure, B), suggestive of dematiaceous fungal keratitis, and the culture grew Curvularia species. Treatment was altered as per culture report, and the patient responded to topical natamycin and itraconazole with healing of the infiltrate with scar formation and visual improvement. Hence, all corneal infiltrates with tentacles may not be Pythium even with characteristic clinical appearance.


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