Macroscopic pigmentation in a dematiaceous fungal keratitis

The diagnosis of fungal keratitis can be difficult and is often delayed. The distinction between moniliaceous and dematiaceous (pigmented) keratomycoses is not commonly possible on clinical examination. We report a case of a Curvularia lunata fungal keratitis in a 40-year-old patient who presented with diffuse brown pigmentation throughout the ulcer bed. Histologic staining and growth on Sabourad's dextrose agar demonstrated the brown pigmentation characteristic of this pigmented fungus. We call attention to this clinical pigmentation as a helpful clue in the detection of dematiaceous fungal keratitis.