First report of Lasiodiplodia pseudotheobromae keratitis susceptible to voriconazole in an Indian mango grower

The family Botriosphaeriacea comprises cosmopolitan endophytic fungi and many of the genera have frequently been implicated in causing human infections, including subcutaneous infection, sinusitis, invasive mycoses and keratitis. Among them, the genus Lasiodiplodia, which contains >30 species, is grouped as coelomycetous fungi with prototype species Lasiodiplodia theobromae as an important cause of keratitis. Several cryptic species morphologically resembling L. theobromae exist, one of which is Lasiodiplodia pseudotheobromae. We present a rare case of mycotic keratitis in an Indian mango grower following penetrating trauma to the left eye. Direct microscopy revealed retractile hyphal elements, and fungal cultures yielded a dematiaceous mould which was confirmed by sequencing as L. pseudotheobromae. Antifungal susceptibility testing revealed low MICs to amphotericin B and voriconazole and increased MICs to itraconazole and posaconazole. This is the first report of phytopathogenic L. pseudotheobromae keratitis, successfully treated with 2 % voriconazole without keratoplasty.