PMC9888008_01
(A) - Slit-lamp image with visualization of anterior peripheral stromal infiltrate; (B) - An extensive area that is stained with fluorescein; (C) - Corneal-OCT shows epithelial and stromal changes - the green arrows under the caption on this figure (on the left) correspond to the cornea that is expressed in all its extension and by layers in (C) (on the right).
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On D15, the patient reported a progressive deterioration of symptoms and the slit lamp examination revealed a paracentral corneal ulcer with an associated stromal infiltration occupying mainly the inferior temporal quadrant and measuring 4.7mmx2.7mm (shown in Figure 1A and B). Epithelial changes as well as stromal disorganization (shown in Figure 1C) were visible on corneal - Optical Coherence Tomography (Corneal-OCT) (Spectralis  Anterior Segment Module, version 1.10.2.0, Heidelberg Engineering, Heidelberg, Germany). 
Microscopic examination of the colonies: pigmented septate hyphae with chains of ovate conidia with transverse and vertical septa.
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The microbiological study revealed a considerable growth of pigmented filamentous fungus identified as Alternaria alternata (shown in Figure 2) both by microscopic morphology and mass spectrometry through the VITEK  MS system, which consists of an automated microbial identification system that uses Matrix Assisted Laser Desorption Ionization Time-of-Flight (MALDI-TOF). 
(A) - Slit-lamp image with visualization of a paracentral leukoma; (B) - Leukoma that no longer is stained with fluorescein; (C) - Corneal-OCT demonstrates an improvement in stromal organization - the green arrows under the caption on this figure (on the left) correspond to the cornea that is expressed in all its extension and by layers in Figure 1C (on the right).
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In the 4th month, the BCVA was 20/25 and, at the slit lamp observation, no ulcer was detected, there was only a paracentral leukoma no longer stained with fluorescein (shown in Figure 3A and B) and the Corneal-OCT demonstrated an improvement in corneal stromal and epithelial anatomy (shown in Figure 3C).