Collagen cross-linking with riboflavin-induced aggravation of polymicrobial keratitis

A 21-years-old female presented with pain, redness, watering, and diminished vision in right eye (OD). Slit lamp biomicroscopy revealed infective keratitis and microbiological tests revealed mixed infection of bacteria and fungus. The patient was treated with a combination of topical (antibacterial and antifungal) medication and oral itraconazole. The patient showed no response. Tab voriconazole was added. Observing no response after another week, collagen cross-linking was performed. On day two, sudden worsening of corneal infiltrates involving total cornea was observed. Topical colistin 0.19% drops were added. The patient did not respond to treatment and a therapeutic graft was performed. The postoperative period was uneventful and no recurrence was observed.