Rare case of Colletotrichum coccodes causing chronic fungal keratitis in an elderly female: Diagnostic delay and antifungal resistance

Abstract

Fungal keratitis is a vision-threatening corneal infection, most commonly caused by Fusarium and Aspergillus. We report a rare case of keratitis caused by Colletotrichum coccodes in an elderly patient with a chronic corneal ulcer refractory to fluconazole. Initial corneal scrapings were negative, delaying diagnosis. Repeat deep biopsy, fungal culture and pan-fungal polymerase chain reaction confirmed C. coccodes. The patient was managed with intensive topical amphotericin B and voriconazole, alongside a glycerol-preserved corneal patch graft to provide tectonic support.
Contribution: This case highlights the diagnostic and therapeutic challenges of chronic fungal keratitis and illustrates the limitations of empiric antifungal therapy in the absence of culture-based guidance.