An Uncommon Mould in an Uncommon Place: A Case of Scopulariopsis brevicaulis Keratitis From the Northern Himalayas, India

Scopulariopsis brevicaulis is an uncommon cause of fungal keratitis, usually occurring after ocular trauma, and is associated with therapeutic difficulties because of its limited susceptibility to antifungal agents. We report the case of a 48-year-old man who presented with pain, redness, and watering of the left eye for one month following injury by iron foreign body particles during welding. Ocular examination revealed a corneal ulcer with hypopyon and markedly reduced visual acuity (2/60). Initial microscopic evaluation was negative for fungal elements; however, fungal culture after extended incubation yielded growth of S. brevicaulis, identified based on colony characteristics and microscopic morphology. Imaging further demonstrated left-sided dacryoadenitis. The patient was treated conservatively with intensive topical natamycin and voriconazole, along with systemic ketoconazole and supportive topical antibiotics. This approach led to clinical improvement, although some degree of visual impairment persisted. This case highlights the importance of maintaining a high index of suspicion, allowing prolonged incubation of fungal cultures, and initiating timely targeted antifungal therapy in rare mould keratitis to achieve favorable outcomes and potentially avoid surgical intervention.