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

Summary

This report describes two patients who developed rare fungal eye infections caused by Curvularia geniculata after eye injuries. Both patients were successfully treated with antifungal eye drops, particularly natamycin. Molecular testing confirmed the specific fungus causing the infection. Both patients recovered well with excellent vision restoration, demonstrating that proper diagnosis and targeted antifungal treatment can effectively manage this rare condition.

Background

Fungal keratitis remains a significant cause of visual impairment worldwide, with dematiaceous fungi including Curvularia species emerging as important pathogens. Keratitis caused by Curvularia geniculata is relatively rare, and current knowledge of its clinical features and treatment remains limited.

Objective

To report two cases of C. geniculata keratitis confirmed through molecular identification and describe their successful management with natamycin-based therapy. The authors aim to contribute to understanding of the clinical features, diagnosis, and management of this uncommon fungal keratitis.

Results

Both isolates were definitively identified as C. geniculata through 100% sequence identity with reference strain. Both isolates were sensitive to natamycin at 2 μg/mL. Patient 1 was treated with natamycin and voriconazole combination therapy, while Patient 2 received natamycin monotherapy. Both patients achieved complete healing with excellent visual outcomes (20/20 and 20/16 respectively).

Conclusion

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