J Korean Ophthalmol Soc.  2014 Sep;55(9):1384-1387. 10.3341/jkos.2014.55.9.1384.

A Case of Fungal Keratitis Caused by Paecilomyces lilacinus after Penetrating Keratoplasty

• Won JY
• Shin JY
• Hwang JH
• Joo CK

• KMID: 2217126
• DOI: http://doi.org/10.3341/jkos.2014.55.9.1384

Abstract

PURPOSE
To report a case of corneal ulcer caused by Paecilomyces lilacinus after penetrating keratoplasty.
CASE SUMMARY
A 67-year-old male with a history of penetrating keratoplasty in the left eye 7 years prior and re-penetrating keratoplasty in the left eye due to graft failure in June 2013, visited our clinic for ocular pain and conjunctival injection in the left eye 3 days in duration. Corneal scrapings were performed for Gram and fungal stains and cultures. The patient was admitted to the hospital for hourly topical fortified ceftazidime and amphotericin B. Despite intensive topical therapy, no improvement was observed. Three days later, fungal culture confirmed Paecilomyces lilacinus and topical voriconazole was prepared from the intravenous formulation and was administered topically and intravenously. Despite medical therapy with voriconazole, perforation occurred requiring a tectonic keratoplasty.
CONCLUSIONS
Keratitis caused by Paecilomyces lilacinus is difficult to eradicate and refractory to amphotericin B. We suggest early use of topical eyedrops, intracameral, and intravitreal injections of voriconazole may be an appropriate treatment for patients with Paecilomyces lilacinus keratitis.

Keyword

Corneal ulcer; Paecilomyces lilacinus; Penetrating keratoplasty

MeSH Terms

Aged
Amphotericin B
Ceftazidime
Coloring Agents
Corneal Transplantation
Corneal Ulcer
Humans
Intravitreal Injections
Keratitis*
Keratoplasty, Penetrating*
Male
Ophthalmic Solutions
Paecilomyces*
Transplants
Amphotericin B
Ceftazidime
Coloring Agents
Ophthalmic Solutions

Figure

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  Figure 1. Pre-therapeutic photograph. 3.8 × 6 mm sized corneal ulcer with feathery margin (arrow) and deep stromal infiltration were observed on initial presentation.

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  Figure 2. Post-therapeutic photograph (8 days). Corneal perforation and collapsed anterior chamber was observed after using voriconazole eyedrop for 2 days.

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  Figure 3. Post-therapeutic keratoplasty photograph. Well grafted cornea and slight descemet membrane (DM) folding was observed at 7 days after penetrating keratoplasty. And there was no infection sign in left eye.

Reference

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