Microcyclosporella mali: a novel fungal keratitis in a post-penetrating keratoplasty patient

An 86-year-old woman underwent penetrating keratoplasty for pseudophakic bullous keratopathy and presented with an acute corneal ulcer thereafter. Examination demonstrated a fluffy white infiltrate and epithelial defect with subsequent endothelial plaque formation and anterior chamber inflammation. The ulcer was cultured, and fortified topical vancomycin and tobramycin were initiated but failed to significantly improve the clinical course. Cultures were ultimately positive for fungus Microcyclosporella mali that responded well to topical natamycin with stabilisation of the ulcer after 6 weeks of topical therapy. This is the first reported case of fungal keratitis due to M. mali .