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Phaeoacremonium iranianum – a new corneal pathogen

Summary

A 66-year-old man developed a serious eye infection from a fungus called Phaeoacremonium iranianum after his eye was scratched by a leaf. This is the first reported case of this fungus causing a corneal infection. Doctors treated the infection with antifungal eye drops and surgery to remove infected tissue, and the patient’s condition improved over time, though with some permanent scarring of the cornea.

Background

Phaeoacremonium fungi are typically found in soil, wood, and plant matter and rarely cause human infections. While phaeohyphomycosis cases have been documented with several Phaeoacremonium species, reports of corneal infections caused by P. iranianum are lacking. Fungal keratitis is an emerging cause of severe sight-threatening ocular disease with longer healing times and higher rates of corneal perforation.

Objective

To present and analyze a rare case of corneal infection caused by Phaeoacremonium iranianum and contribute to clinical understanding and management of this newly identified corneal pathogen.

Results

P. iranianum was identified as the causative organism through molecular sequencing. Antifungal susceptibility testing showed lowest MIC values for amphotericin (0.05 µg/ml) and voriconazole (0.5 µg/ml), with high resistance to fluconazole (64 µg/ml). Combined keratectomy and voriconazole therapy controlled the infection, resulting in corneal opacity with local thinning one month post-treatment.

Conclusion

Clinicians should be alert to P. iranianum as a newly identified corneal pathogen. Proper strain identification and antifungal susceptibility testing are crucial for optimal treatment. This case demonstrates that keratectomy combined with natamycin and voriconazole can be effective, with corneal transplantation considered for severe cases.
  • Published in:BMC Ophthalmology,
  • Study Type:Case Report,
  • Source: PMID: 40264033, DOI: 10.1186/s12886-025-04064-1
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