MYCOLab Ai Logo - gold and army green

A Rare Case of Alternaria citri Keratitis Successfully Treated with Voriconazole

Summary

A 71-year-old woodworker developed a serious eye infection caused by a rare fungus called Alternaria citri that damaged his cornea. Doctors identified the fungus using genetic testing and treated it with the antifungal drug voriconazole combined with surgery. After one year, his vision improved and the infection did not return, marking the first documented case of this particular fungal infection in humans.

Background

Alternaria species are dematiaceous fungi causing opportunistic ocular infections, particularly in immunocompromised individuals or those with corneal epithelial disruption. Fungal keratitis is the fourth leading cause of corneal blindness worldwide with 1.5-2.0 million new cases annually. Previous reports have documented keratitis caused by A. alternata and A. tenuissima, but A. citri has not been previously reported in human cases.

Objective

To describe a rare case of fungal keratitis caused by Alternaria citri in a 71-year-old male patient and document the successful treatment approach using voriconazole. This represents the first reported human case of A. citri keratitis in the literature.

Results

Filamentous fungi growth was identified on SGC agar after 48 hours with characteristic dematiaceous morphology. PCR-ITS sequencing confirmed identification as Alternaria citri with 98.19% coverage and 100% sequence similarity. Patient showed progressive clinical remission following voriconazole and natamycin treatment with complete resolution and no relapse at one-year follow-up with clear graft and best-corrected visual acuity of 20/63.

Conclusion

This case confirms voriconazole as an effective therapeutic option for Alternaria keratitis, particularly in cases refractory to conventional agents. Rapid and accurate fungal identification using molecular tools combined with timely surgical and targeted antifungal therapy is essential for optimizing visual outcomes in fungal keratitis. Increased clinical awareness of emerging Alternaria species is critical for appropriate management.
  • Published in:Journal of Fungi,
  • Study Type:Case Report,
  • Source: PMID: 41295185, DOI: 10.3390/jof11110805
Scroll to Top