{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T11:48:39Z","timestamp":1778759319877,"version":"3.51.4"},"reference-count":15,"publisher":"BMJ","issue":"5","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2025,5,5]]},"published-print":{"date-parts":[[2025,5]]},"abstract":"<jats:p>A middle-aged woman presented with left eye redness and pain after trauma with a wooden stick. A greyish white anterior stromal infiltrate with overlying epithelial defect and surrounding pin-head like infiltrates was observed in the left cornea. Corneal scraping showed fungal hyphae on smears and was later identified as <jats:italic>Macrophomina phaseolina<\/jats:italic>. Despite hourly topical natamycin 5% and oral ketoconazole, the infiltrates progressed in a migrating ring pattern. Voriconazole 1% eye drops were added, along with two intrastromal amphotericin B (5\u2009\u00b5g\/0.1\u2009mL) injections a week apart, after which response was noted. Natamycin was stopped, and voriconazole monotherapy was continued for a month after its initiation. After 5\u2009months, the infiltrate resolved without recurrence. This case highlights <jats:italic>Macrophomina<\/jats:italic> keratitis which mimicked <jats:italic>Nocardia<\/jats:italic> and <jats:italic>Pythium<\/jats:italic> infections and demonstrates successful treatment with topical voriconazole.<\/jats:p>","DOI":"10.1136\/bcr-2024-260237","type":"journal-article","created":{"date-parts":[[2025,5,15]],"date-time":"2025-05-15T23:45:26Z","timestamp":1747352726000},"page":"e260237","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["<i>Macrophomina phaseolina<\/i> keratitis: treatment approach for poor response to topical natamycin"],"prefix":"10.1136","volume":"18","author":[{"given":"Poornima","family":"Tandra","sequence":"first","affiliation":[{"name":"Shantilal Shanghvi Cornea Institute, LV Prasad Eye Institute GMR Varalakshmi Campus, Visakhapatnam, Andhra Pradesh, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sanchita","family":"Mitra","sequence":"additional","affiliation":[{"name":"Jhaveri Microbiology Centre, LV Prasad Eye Institute, Hyderabad, Telangana, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bhagyashree","family":"Madduri","sequence":"additional","affiliation":[{"name":"Ocular Microbiology Services, LV Prasad Eye Institute GMR Varalakshmi Campus, Visakhapatnam, Andhra Pradesh, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-2407-7787","authenticated-orcid":false,"given":"Shilpa","family":"Tarini","sequence":"additional","affiliation":[{"name":"Cornea and Anterior Segment Services, Shantilal Shanghvi Cornea Institute, LV Prasad Eye Institute, Visakhapatnam, Andhra Pradesh, India"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,5,15]]},"reference":[{"key":"2025082802002713000_18.5.e260237.1","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(20)30448-5"},{"key":"2025082802002713000_18.5.e260237.2","doi-asserted-by":"crossref","first-page":"1308","DOI":"10.1038\/eye.2008.298","article-title":"Fungal keratitis in the United Kingdom 2003-2005","volume":"23","author":"Tuft","year":"2009","journal-title":"Eye (Lond)"},{"key":"2025082802002713000_18.5.e260237.3","doi-asserted-by":"publisher","DOI":"10.1016\/j.ophtha.2010.03.048"},{"key":"2025082802002713000_18.5.e260237.4","doi-asserted-by":"publisher","DOI":"10.1111\/j.1442-9071.2009.02155.x"},{"key":"2025082802002713000_18.5.e260237.5","doi-asserted-by":"crossref","first-page":"1990","DOI":"10.4103\/ijo.IJO_1602_21","article-title":"Clinical and mycological profile of fungal keratitis from North and North-East India","volume":"70","author":"Tawde","year":"2022","journal-title":"Indian J Ophthalmol"},{"key":"2025082802002713000_18.5.e260237.6","doi-asserted-by":"crossref","first-page":"912","DOI":"10.4103\/ijo.IJO_821_17","article-title":"Fungal keratitis: The Aravind experience","volume":"65","author":"Prajna","year":"2017","journal-title":"Indian J Ophthalmol"},{"key":"2025082802002713000_18.5.e260237.7","doi-asserted-by":"publisher","DOI":"10.4103\/0301-4738.53051"},{"key":"2025082802002713000_18.5.e260237.8","doi-asserted-by":"crossref","DOI":"10.3390\/jof7040273","article-title":"Mycotic Keratitis-A Global Threat from the Filamentous Fungi","volume":"7","author":"Hoffman","year":"2021","journal-title":"J Fungi (Basel)"},{"key":"2025082802002713000_18.5.e260237.9","doi-asserted-by":"crossref","first-page":"1048","DOI":"10.4103\/ijo.IJO_1612_18","article-title":"Causative fungi and treatment outcome of dematiaceous fungal keratitis in North India","volume":"67","author":"Kumar","year":"2019","journal-title":"Indian J Ophthalmol"},{"key":"2025082802002713000_18.5.e260237.10","doi-asserted-by":"crossref","first-page":"709","DOI":"10.1097\/ICO.0000000000002825","article-title":"Predictive Factors for Resolution of Dematiaceous Fungal Keratitis","volume":"41","author":"Chaudhary","year":"2022","journal-title":"Cornea"},{"key":"2025082802002713000_18.5.e260237.11","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1016\/j.mmcr.2012.10.007","article-title":"Fungal keratitis caused by Macrophomina phaseolina - A case report","volume":"1","author":"Premamalini","year":"2012","journal-title":"Med Mycol Case Rep"},{"key":"2025082802002713000_18.5.e260237.12","doi-asserted-by":"crossref","unstructured":"Ahirwar LK , Sheba E , Jakati S , et al . 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