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Two Cases of Curvularia geniculata Keratitis Successfully Treated with Natamycin-Based Therapy

Summary

Two patients developed rare fungal eye infections caused by Curvularia geniculata after eye injuries from plant material. The infections caused corneal ulcers with characteristic feathery infiltrates. Both patients were successfully treated using natamycin eyedrops, either alone or combined with voriconazole, and both recovered excellent vision. Accurate identification of the fungus using genetic testing confirmed the diagnosis and helped guide treatment decisions.

Background

Fungal keratitis caused by dematiaceous fungi, including Curvularia species, remains a significant cause of visual impairment worldwide. Curvularia geniculata keratitis is relatively rare with limited knowledge of its clinical features and treatment options. This report addresses the need for better understanding of this uncommon fungal infection.

Objective

To describe two cases of Curvularia geniculata keratitis that were successfully treated with natamycin-based therapy and to contribute to understanding of the clinical features, diagnosis, and management of this rare fungal infection through molecular identification.

Results

Both isolates were definitively identified as Curvularia geniculata through tef1-α sequencing with 100% identity. Both isolates showed sensitivity to natamycin at 2 μg/mL. Patient 1 received combination therapy with natamycin and voriconazole and achieved complete healing with 20/20 visual acuity. Patient 2 received natamycin monotherapy and recovered to 20/16 visual acuity with minimal scarring.

Conclusion

Curvularia geniculata keratitis can be effectively managed with natamycin-based therapy. Molecular identification is crucial for accurate species-level differentiation within the Curvularia genus. Treatment choice between monotherapy and combination therapy may be guided by clinical severity and antifungal susceptibility testing results.
  • Published in:Mycopathologia,
  • Study Type:Case Report,
  • Source: PMID: 40944879, DOI: 10.1007/s11046-025-00997-9
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