Exophiala Lecanii-Cornikeratitis Presenting As A Serpiginous Pigmented Superficial Lesion: A Case Report

Rationale: Patients with bullous keratopathy (BK) treated by Descemet stripping automated endothelial keratoplasty (DSAEK) have a compromised cornea, due to the administration of topical steroid, postsurgical use of contact lenses, and impaired barrier function of the corneal epithelium by BK. We report a case ofExophiala lecanii-corni(E lecanii-corni)keratitis presenting as a serpiginous pigmented superficial lesion after DSAEK. Patient concerns: An 81-year-old woman who had undergone cataract surgeries, suffered from decreased vision in the left eye. She was diagnosed BK and she underwent DSAEK. Two months after DSAEK, a pigmented superficial lesion developed on the left cornea. The lesion migrated and recurred repeatedly and she was referred to our department. Best corrected vision was 20/220. Diagnoses: Light microscopy of a corneal scraping revealed branching fungal hyphae. Fungal culture showed growth of a black colony, identified asE lecanii-corniby ribosomal DNA sequencing. Interventions: We started topical treatment with 1% voriconazole and 1.5% levofloxacin. Antifungal susceptibility testing showed that the minimum inhibitory concentration of voriconazole was 0.06 mu g/mL. Outcomes: The lesion scarred after treatment for 3 months, and left best corrected vision improved to 20/40. Lessons: GenusExophialais known as 1 of the "black molds" and a cause of chromomycosis. This is the first description ofE lecanii-cornikeratitis, and pigmented corneal epithelial lesions may be characteristic of this fungal genus.