case_images: PMC10091228_01
case_images: Slit lamp findings at the first visit show bilateral peripheral ulcerative keratitis that ranged from the nasal to superior areas. While the keratitis in the right eye was inactive (a), the left eye exhibited feathery infiltration at 9 o'clock in the peripheral cornea with ciliary injection, inflammation of the anterior chamber, and fibrin at the pupil (b).
case_images: cop529979_f01.jpg
case_images: PMC10091228_01_cop529979_f01.jpg
case_images: F1
case_images: Although peripheral ulcerative keratitis ranging from the nasal to superior area was observed in both eyes, that of the right eye appeared to be inactive as the ulcer was re-epithelized and there was no ciliary injection (Fig. 1a). A feathery corneal infiltration was seen at 9 o'clock in the left peripheral cornea (Fig. 1b).
case_images: Slit lamp findings of the left eye after the lamellar keratoplasty show the oval-shaped lamellar corneal graft in the nasal peripheral cornea. Although the feathery infiltration in the deep stroma remained on the day after the initial surgery (a), it disappeared after 3 months (b).
case_images: cop529979_f02.jpg
case_images: PMC10091228_01_cop529979_f02.jpg
case_images: F2
case_images: The surgical procedure included adjacent conjunctival resection, an oval shape removal of the necrotic superficial cornea to about 4/5 depth of corneal stroma, debridement of the feather-like lesion, and the reconstruction of the cornea using a lamellar donor cornea (Fig. 2a). At 3 months after the initial visit, his left best-corrected visual acuity finally recovered to 0.7 (Fig. 2b).
case_images: Giant colony of Alternaria alternata isolated in this report. a The colony on a potato-dextrose agar plate appears greenish in color and fuzzy on the surface (28 C, 8 days). b The reverse side was pigmented.
case_images: cop529979_f03.jpg
case_images: PMC10091228_01_cop529979_f03.jpg
case_images: F3
case_images: Alternaria species by findings of the DNA sequencing of the internal transcribed spacer (ITS) region of ribosomal DNA (Fig. 3a, b). An antifungal susceptibility test was performed based on the Clinical and Laboratory Standards Institute (CLSI) M38-A2 standard.