First report of a ring corneal ulcer caused by Cladorrhinum bulbillosum posing a diagnostic debacle: A case report

A young diabetic male patient presented with a ring infiltrate and hypopyon of 1-day onset in the left eye. Though we suspected acanthamoeba keratitis, the initial smear report showed fungal filaments. So, we started dual topical with systemic antifungals. On day 3, the ring was filled with a reddish-brown infiltrate, and the culture grew pale-gray fungal colonies. A clinical diagnosis of dematiaceous fungi was made, commonly observed at our clinic is Curvularia, which responds to the chosen treatment combination. Due to clinical worsening, we considered therapeutic penetrating keratoplasty that got delayed until diabetic control. With further worsening, we re-scraped with a day off medication and performed confocal microscopy and polymerase chain reaction (PCR). The organism was identified as Cladorrhinum bulbillosum from the DNA extract from colonies grown in blood agar when subjected to PCR-based sequencing carried out in the ABI 3130 genetic analyzer. The patient underwent therapeutic penetrating keratoplasty on day 11.