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Keratomycosis caused by a rare fungus: Exserohilum rostratum

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Keratomycosis is an invasive fungal infection of the cornea which usually occurs following corneal trauma by vegetative material. It is usually caused by hyaline fungus such as Aspergillus, Fusarium and Acremonium, but rare case reports with phaeoid fungus have been reported. We report here a case of keratomycosis caused by Exserohilum rostratum. E. rostratum is a dematiaceous fungus that has been known to cause sinusitis and subcutaneous infections but it has rarely been reported to be a cause of keratomycosis. A 60 year old man presented with decreased vision in the left eye since 1 month following trauma. He was diagnosed to have corneal ulcer for which the patient underwent two therapeutic keratoplasty and was given Moxifloxacin. But there was no improvement in the vision. Later E. rostratum was isolated from his corneal scrapings. Topical natamycin was applied and oral itraconazole was started to which the patient vision improved gradually. Although E. rostratum is a rare cause of keratomycosis, but if diagnosed on time and treated appropriately, it can result in complete resolution of vision.