Infected cornea graft mimicking scleral tissue transplant: A deviant case of failed graft with dystrophic calcification and secondary fungal infection

A 56-year-old female patient presented with vision loss in right eye (OD) for the past 6 months with whitish discoloration of the eye; the patient underwent therapeutic keratoplasty 1 year back elsewhere, and was on treatment with topical fortified antibiotics, lubricants, and antiglaucoma medications for 6 months. On examination, a chalky white opacified graft was noted, simulating scleral tissue transplant with edematous vascularized host corneal tissue. Corneal scraping was positive for fungal elements on potassium hydroxide mount, and culture on Sabouraud agar reported hyalohyphomycetes growth. Therapeutic keratoplasty was performed, and histopathological evaluation (HPE) revealed corneal tissue with areas of necrosis, karyorrhectic debris with mixed inflammatory cell infiltrate, and dystrophic calcification in the stroma.