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First report of Stemphylium lycopersici keratitis, a complex corneal infection case

Summary

A 66-year-old man developed a severe corneal infection from a stone chip injury that didn’t improve with standard antibiotics. Doctors discovered the infection was caused by a rare plant fungus called Stemphylium lycopersici, combined with a herpes virus. Using advanced genetic testing (mNGS) to identify the exact pathogens, they prescribed targeted antifungal and antiviral medications along with a corneal transplant, successfully healing the infection and preserving his vision.

Background

Corneal opacities are a leading cause of blindness worldwide. Fungal keratitis is a severe condition that often resists treatment and has a worse prognosis than bacterial keratitis. Mixed polymicrobial infections constitute approximately 2-15% of infectious keratitis cases.

Objective

To present the first documented case of keratitis caused by Stemphylium lycopersici, a filamentous fungus, and to demonstrate the importance of metagenomic next-generation sequencing (mNGS) in identifying rare pathogens in corneal infections.

Results

mNGS analysis revealed a mixed infection with Stemphylium lycopersici (94.91% relative abundance) and human alphaherpesvirus 1 (95.45% relative abundance). Traditional fungal and bacterial cultures yielded negative results. With targeted therapy including voriconazole, natamycin, ganciclovir, and corneal lesion removal with amniotic membrane transplantation, the corneal ulcer nearly healed within three months.

Conclusion

This is the first documented case of fungal keratitis caused by S. lycopersici and the first case of mixed fungal-viral corneal infection. mNGS enables rapid and accurate pathogen identification in refractory infectious keratitis, facilitating targeted therapy and reducing antibiotic resistance compared to empirical treatment approaches.
  • Published in:Journal of Ophthalmic Inflammation and Infection,
  • Study Type:Case Report,
  • Source: PMID: 40423743, DOI: 10.1186/s12348-025-00505-6
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