Chronic necrotizing sclerouveitis caused by Alternaria doliconidium

Purpose: To report a case of fungal sclerouveitis caused by Alternaria doliconidium, misdiagnosed as autoimmune scleritis and incorrectly treated with immunosuppressive therapy. Observations: A 69-year-old man presented with progressive chronic necrotizing scleritis in his right eye following ocular trauma. Initial treatment with antimicrobial and steroid therapy showed no improvement, and a scleral biopsy yielded inconclusive results. Autoimmune scleritis was suspected, leading to treatment with systemic steroids and immunosuppressants. Upon further examination, nodular necrotizing scleritis with scleral translucency and whitish floccules in the anterior chamber was observed, prompting a suspicion of fungal etiology. Molecular analysis via PCR confirmed the presence of Alternaria doliconidium. Conclusions and Importance: This case underscores the importance of considering fungal pathogens in cases unresponsive to conventional treatment and the critical role of advanced molecular diagnostics. This is the first reported case of sclerouveitis caused by Alternaria doliconidium, expanding the spectrum of ocular infections associated with this genus.