Journal of Clinical and Diagnostic Research. 2015 Feb, Vol-9(2): DD01-DD02 1 1 DOI: 10.7860/JCDR/2015/10843.5529 Case Report CASE REPORT A 54-year-old male patient attended the Ophthalmology OPD of Himalayan Institute of Medical Sciences Dehradun in January 2012. An electrician by profession he complained of pain, mild watering, photophobia and gradual loss of vision in right eye. He was on topical Norfloxacin eye drops but without much relief since 1 month. Uncorrected visual acuity of the right eye was 6/60. On examination, mild oedema was observed in the upper and lower lids of the right eye. Slit lamp examination revealed a 4x5 mm sized, para-central corneal ulcer 5 mm from the limbus on the inferior nasal aspect [Table/Fig-1]. The ulcer was dry- looking with irregular margins and stromal infiltrates but there was no evidence of feathery margins. Satellite lesions were not seen and there was no evidence of immune ring. Infiltration involved all the layers of the cornea. There was an immobile hypopyon of 2 mm height from the limbus, present inferiorly. No pigmentation was noticed and lens and posterior segment were normal. Left eye was normal. A provisional diagnosis of fungal corneal ulcer was made. He did not reveal any history of trauma to the eye in the past. A direct KOH (Potassium hydroxide) mount from the corneal scraping revealed the presence of few septate hyaline hyphae. Growth on SDA (Sabouraud’s dextrose agar) was obtained within a week and greyish black mycelia with numerous black sclerotia and a brown colour on the obverse and reverse covering the whole of the culture tube was seen [Table/Fig-2a&b]. A LCB (Lactophenol cotton blue) tease mount from the growth on CMA (Corn meal agar) revealed acervular conidiomata with abundant setae, fusiform conidia and abundant appressoria with irregular margins [Table/Fig-3]. The slide cultures on PDA (Potato Dextrose Agar) after five days of growth at 25°C revealed hyaline, septate hyphae. Conidiomata were acervular, with 2 to 5 brown setae which had tapering ends [Table/Fig-4]. Long conidia which were hyaline, aseptate and fusiform with straight and parallel walls and abruptly tapered ends were seen. Also few light brown appressoria were found. Antifungal susceptibility testing was performed according to the Clinical and Laboratory Standards Institute guidelines(M38-A2). The antifungal agents used included Amphotericin B (10 U), Fluconazole (25 μg), Ketoconazole (10 μg) and Voriconazole (10 μg).The isolate was found to be sensitive to Amphotericin B and Voriconazole and the patient was treated successfully with ocular administration of Amphotericin B for 2 month. The patient was followed up regularly with no evidence of any reoccurrence. DISCUSSION We report for the first time the isolation of C. coccodes from India in a patient who had none of the known predisposing factors for this infection. He was successfully treated with ocular administration of Amphotericin B, contrary to the standard practice of surgical management for this condition. Six of the 66 species of Colletotrichum have been implicated in human infections till date [1-4]. Though all of them have been isolated from eye infections world over, to the best of our knowledge, C. coccodes has been reported seldom from cases of keratitis [4-6]. Identification of the infecting species has therapeutic relevance, in view of species- specific antifungal susceptibility profile observed with Colletotrichum [7]. However, species identification, on the basis Keywords: Amphotericin, Ocular, Phaeohyphomycosis Microbiology Section Non Traumatic Keratitis Due to Colletotrichum Coccodes: A Case Report AARTI KOTWAL 1 , DEBASIS BISWAS 2 , BARNALI KAKATI 3 , HARSH BAHADUR 4 , NEETI GUPTA 5 ABSTRACT Colletotrichum species, a rare and emerging fungus is a well- known plant pathogen and an uncommon cause of human infection. It has been implicated as the etiological agent of cutaneous phaeohyphomycosis and keratitis, particularly following colonization of traumatized tissues or in immunocompromised patients. However, it has hardly ever been reported in the absence of such predisposing risk factors. Here, we report a case of keratitis with Colletotrichum coccodes occurring in a middle- aged, immunocompetent person without any history of trauma or co-morbidity. The isolate was sensitive to Amphotericin B and Voriconazole, and accordingly the patient was treated successfully with ocular administration of Amphotericin B. a b [Table/Fig-1]: Photograph of the affected eye showing the fungal ulcer (white arrow) and hypopyon (black arrow) [Table/Fig-2]: a) Obverse image- Colonies of Colletotrichum coccodes as noted on cornmeal agar, b) Reverse image-Colonies of Colletotrichum coccodes as noted on cornmeal agar [Table/Fig-3]: Lactophenol cotton blue (LCB) mount of Colletotrichum coccodes showing the appresoria (black arrow) and fusiform nonseptate conidia (yellow arrow)