Equine Fungal Keratitis due to Cladorrhinum bulbillosum.

Multimodal therapy with voriconazole, luliconazole, and surgical intervention successfully resolved rare C. bulbillosum equine fungal keratitis.

This case report describes equine fungal keratitis caused by Cladorrhinum bulbillosum in a 14-year-old Bashkir Curly gelding presenting with a complicated corneal ulcer of the left eye. Diagnosis was established through corneal cytology, aerobic and mycologic cultures, and next-generation sequencing (NGS), which identified C. bulbillosum as the predominant organism. Fungal culture further supported a filamentous fungal infection. Surgical management included anterior stromal keratectomy, cryotherapy of the keratectomy bed, biological scaffold graft placement, and temporary tarsorrhaphy. An inferior eyelid subpalpebral lavage (SPL) system was placed intraoperatively to facilitate postoperative topical drug delivery. The medical protocol included topical antibacterials (ofloxacin, cefazolin), antifungals (voriconazole and luliconazole), anticollagenase therapy (serum), and atropine, along with systemic anti-inflammatories. Reevaluations were conducted every 2–3 weeks, and the corneal ulcer resolved over an 8-week period with only minor scarring. To the authors' knowledge, this represents only the second reported case of equine fungal keratitis attributable to C. bulbillosum. The case underscores the diagnostic value of NGS for identifying uncommon fungal pathogens and demonstrates the efficacy of a multimodal treatment approach combining contemporary antifungals—including the novel topical agent luliconazole—with surgical intervention in managing refractory equine fungal keratitis.

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