Supplementary Material for: Successful management of fungal keratitis by Alternaria alternata complicating Mooren’s ulcer

Mooren’s ulcer is an idiopathic peripheral ulcerative keratitis whose pathogenesis is thought to be due to an autoimmune reaction. Topical steroids are the first line treatment for Mooren’s ulcer and difficult to be discontinued. In this case, the 76-year-old patient receiving topical steroids for bilateral Mooren’s ulcer developed a feathery corneal infiltration and perforation in the left eye. On suspicion of a fungal keratitis complication, we started topical voriconazole treatment and performed lamellar keratoplasty. Topical betamethasone was continued twice a day. The identified causative fungus was Alternaria alternata, which is known to susceptible to voriconazole. MIC of voriconazole was later proven to be 0.5 μg/mL. After 3 months treatment, the residual feathery infiltration disappeared and the left vision recovered to 0.7. In this case, topical voriconazole was effective, and the eye was successfully treated with continuing topical steroids. Fungal species identification and antifungal susceptibility test proved helpful for symptom management.