To report a case of Beauveria bassiana keratitis that was confirmed by gene sequencing.

A 70-year-old man presented to our hospital with complaints of ocular pain and deterioration of the visual acuity in his left eye after injury caused by a wood branch one week previously. Visual acuity in the left eye was 20/400 at the time of the first visit. Slit lamp examination showed a central 0.7 × 2.5-mm-sized epithelial defect surrounded by cellular infiltration in the stroma. Scraping of the corneal lesion for microbiological examinations was performed. Initial Gram stain, potassium hydroxide (KOH) mount, and culture were negative. However, fungal hyphae were observed on a KOH mount of the repeated corneal scraping specimen, and a Beauveria species was suspected based on the culture. Beauveria bassiana was confirmed using a MicroSEQ® D2 large-subunit ribosomal DNA fungal sequencing kit. Natamycin eye solution was initially instilled bihourly (every two hours), but the persistent epithelial defect and progressive stromal melting finally resulted in a descemetocele. Temporary and permanent amniotic membrane transplantations were performed, and amphotericin B eye solution was administered bihourly (every two hours). The ulcerous lesion gradually improved with no evidence of recurrence.

Recently, cases of fungal keratitis have been increasing. Therefore, molecular diagnosis methods such as gene sequencing can be helpful in diagnosis and in improving the prognosis of fungal keratitis caused by rare fungi, as we found in this case.