Severe fungal keratitis caused by Lasiodiplodia theobromae following grass trimmer-related ocular trauma: a case report.

Lasiodiplodia theobromae is an uncommon but emerging filamentous fungus primarily recognized as a plant pathogen. We report a case of severe L. theobromae keratitis in a 57-year-old man who presented with left eye pain, redness, and progressive visual loss following grass trimmer-related ocular trauma. Ocular examination revealed diffuse corneal haziness, dense stromal infiltrate, total epithelial defect, and descemetoceles. The organism was isolated from corneal scrapings and identified by microscopy, culture, MALDI-TOF mass spectrometry, and confirmatory ITS sequencing. Management required intensive topical, intravitreal, and systemic antifungal therapy in addition to surgical intervention. Visual acuity remained at light perception at three weeks postoperatively, with no further deterioration observed following combined surgical and medical management. Early diagnosis remains challenging due to overlapping morphological features with other filamentous fungi, necessitating molecular confirmation.