Fungal keratitis presenting as radial keratoneuritis

A 44-year-old man presented with severe pain, redness, watering and photophobia for 10 days in the right eye without any history of trauma. Diagnosis of herpes simplex disciform keratitis was made and he was prescribed topical steroids. The patient showed clinical worsening and presented with ring infiltrate, diffuse stromal oedema and radial keratoneuritis, a finding pathognomic of acanthamoeba keratitis. With two inconclusive corneal scrapings and the patient showing clinical worsening, an urgent therapeutic penetrating keratoplasty was carried out. Histopathological and microbiological examination of the excised corneal button revealed the presence of fungus. At 5 weeks follow-up, the patient has best-corrected visual acuity 20/40 with no recurrence of infection.