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Peer-reviewedCC BYASM case reports

Fusarium falciforme keratitis in a corneal transplant recipient treated successfully with fosmanogepix and intracameral amphotericin B

  • Ashley Zeoli1
  • Christine Shieh2
  • Karen C. Bloch1
  • Lili Tao3
  • Alex Mainor4
  • Christo Cimino5
  • Breann Zeches3
  • Augusto Dulanto Chiang1
5 affiliations
  1. 1Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
  2. 2Department of Ophthalmology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
  3. 3Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
  4. 4Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University, Nashville, Tennessee, USA
  5. 5Department of Pharmaceutical Services, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Abstract

Background: Ocular fungal infections are a major cause of vision loss worldwide. Fusarium spp., a leading cause of fungal keratitis, is often difficult to treat. There are no current standardized treatment guidelines for fungal keratitis. We present a case of Fusarium spp. keratitis that was treated with fosmanogepix and intracameral amphotericin B, highlighting additional treatment options in difficult-to-treat cases. To our knowledge, this is the first report of fosmanogepix use in Fusarium keratitis.

Case Summary: A 72-year-old man presented with 2 weeks of right eye pain and redness and was diagnosed with Fusarium falciforme keratitis via ocular fungal culture. He failed multiple topical, oral, and intraocular antifungal agents, and required corneal transplantation. Histopathology from his explant showed hyaline hyphae with occasional sickle-shaped conidia, consistent with Fusarium spp. The infection recurred in the corneal allograft despite intravitreal voriconazole, intraocular amphotericin B, and topical natamycin. Ultimately, he underwent successful treatment with fosmanogepix, a first-in-class antifungal agent.

Conclusion: Our case illustrates the challenges of managing Fusarium keratitis and the potential role of novel antifungal agents, such as fosmanogepix, as adjuncts to established intraocular and topical therapy in the setting of clinical failure.

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Cite

BibTeXRIS
BibTeX
@article{zeoli2026fusarium,
  title = {{Fusarium falciforme keratitis in a corneal transplant recipient treated successfully with fosmanogepix and intracameral amphotericin B}},
  author = {Ashley Zeoli and Christine Shieh and Karen C. Bloch and Lili Tao and Alex Mainor and Christo Cimino and Breann Zeches and Augusto Dulanto Chiang},
  journal = {ASM case reports},
  year = {2026},
  month = aug,
  doi = {10.1128/asmcr.00033-26},
  url = {https://europepmc.org/article/PMC/PMC13729741},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - Fusarium falciforme keratitis in a corneal transplant recipient treated successfully with fosmanogepix and intracameral amphotericin B
AU  - Ashley Zeoli
AU  - Christine Shieh
AU  - Karen C. Bloch
AU  - Lili Tao
AU  - Alex Mainor
AU  - Christo Cimino
AU  - Breann Zeches
AU  - Augusto Dulanto Chiang
PY  - 2026
DA  - 2026/08/11
JO  - ASM case reports
DO  - 10.1128/asmcr.00033-26
UR  - https://europepmc.org/article/PMC/PMC13729741
AB  - Background: Ocular fungal infections are a major cause of vision loss worldwide. Fusarium spp., a leading cause of fungal keratitis, is often difficult to treat. There are no current standardized treatment guidelines for fungal keratitis. We present a case of Fusarium spp. keratitis that was treated with fosmanogepix and intracameral amphotericin B, highlighting additional treatment options in difficult-to-treat cases. To our knowledge, this is the first report of fosmanogepix use in Fusarium keratitis.  Case Summary: A 72-year-old man presented with 2 weeks of right eye pain and redness and was diagnosed with Fusarium falciforme keratitis via ocular fungal culture. He failed multiple topical, oral, and intraocular antifungal agents, and required corneal transplantation. Histopathology from his explant showed hyaline hyphae with occasional sickle-shaped conidia, consistent with Fusarium spp. The infection recurred in the corneal allograft despite intravitreal voriconazole, intraocular amphotericin B, and topical natamycin. Ultimately, he underwent successful treatment with fosmanogepix, a first-in-class antifungal agent.  Conclusion: Our case illustrates the challenges of managing Fusarium keratitis and the potential role of novel antifungal agents, such as fosmanogepix, as adjuncts to established intraocular and topical therapy in the setting of clinical failure.
SN  - 2996-2684
ER  -