Abstract

A 70 year old man presented with a 2*1mm superficial infiltrate near the limbus following dust exposure to left eye with a vision of 6/36. The cornea had diffusely spread intrastromal reticular lesions .Scraping showed atypical looking fungal filaments because of which confocal was done which showed ribbon like filaments indicating pythium . Culture showed no growth. In the second visit the ulcer increased circumferentially with peripheral guttering inspite of treating with azithromycin and itraconazole. By third visit, vision dropped to hand movement with gross limbal guttering,C shaped paralimbal infiltrate and stromal edema even after fortified linezolid was added. The patient continued to deteriorate and ultimately underwent therapeutic keratoplasty. The button culture had no growth as well. After 3 months of surgery the graft got re- infected an went into complete melt