J Korean Ophthalmol Soc.  2016 Nov;57(11):1795-1800. 10.3341/jkos.2016.57.11.1795.

Keratitis Caused by Paecilomyces lilacinus after Cataract Surgery in a Patient with Systemic and Autoimmune Disease

• Oh SY
• Kang HS
• Lee CK

• KMID: 2357739
• DOI: http://doi.org/10.3341/jkos.2016.57.11.1795

Abstract

PURPOSE
To report a case of Paecilomyces lilacinus fungal keratitis after cataract surgery in a patient with chronic systemic and autoimmune disease who was treated with medical therapy and penetrating keratoplasty.
CASE SUMMARY
A 72-year-old female was referred for decreased visual acuity and ocular pain in the left eye. She underwent cataract surgery in the left eye 1 month earlier and was treated for 2 weeks for corneal edema and stromal infiltration around the corneal suture. She had a chronic systemic disease with hypertension, hyperlipidemia, hepatitis C and rheumatoid arthritis. Suspecting infectious keratitis, the patient was instructed to stop applying topical and systemic steroids and use topical amphotericin B (0.15%) and moxifloxacin (0.5%). However, without improvement, amphotericin B (0.15%) and moxifloxacin (0.5%) were changed to natamycin (5%) and topical voriconazole (2%) and systemic voriconazole was added. However, her systemic status deteriorated and corneal melting developed, scleral graft implantation and amniotic membrane implantation were performed to prevent corneal perforation 6 weeks after the initial visit. Paecilomyces lilacinus was identified in culture at 7 weeks and penetrating keratoplasty was performed 12 weeks after the initial visit. After penetrating keratoplasty, corneal status was stable for 6 months and no signs of recurrence were observed.
CONCLUSIONS
In a patient with Paecilomyces lilacinus fungal keratitis and chronic systemic and autoimmune disease, penetrating keratoplasty showed good prognosis when the disease was refractory to topical and systemic antifungal agents.

Keyword

Fungal keratitis; Paecilomyces lilacinus; Penetrating keratoplasty; Voriconazole

MeSH Terms

Aged
Amnion
Amphotericin B
Antifungal Agents
Arthritis, Rheumatoid
Autoimmune Diseases*
Cataract*
Corneal Edema
Corneal Perforation
Female
Freezing
Hepatitis C
Humans
Hyperlipidemias
Hypertension
Keratitis*
Keratoplasty, Penetrating
Natamycin
Paecilomyces*
Prognosis
Recurrence
Steroids
Sutures
Transplants
Visual Acuity
Voriconazole
Amphotericin B
Antifungal Agents
Natamycin
Steroids
Voriconazole

Figure

• 

  Figure 1. Slit lamp photography. (A) At the initial visit, the epithelial defect with round shape and feathery stromal infiltration was shown on left eye. (B) 4 days after treatment, there were fibrous membranes in the anterior chamber and more increased stromal infiltration than initial visit on left eye.

• 

  Figure 2. Slit lamp photography. (A) 25 days after initial visit, corneal suture and conjunctival flap transposition were done on left eye. (B) After 10 days of admission, iris incarcerated at temporal melted corneal lesion and stromal infiltration was also increased.

• 

  Figure 3. Phtography of culture and photomicrograph. (A) Colony of Paecilomyces lilacinus (P. lilacinus) were isolated from infected cornea after incubating 2 weeks with pink-gray color on sabouraud dextrose agar. (B) Photomicrograph of P. lilacinus was demonstrated the long branching conidiophores arising from hyphae, tapering phialides, and chains of conidia (lactophenol cotton blue stain, ×400).

• 

  Figure 4. Slit lamp photography. After 6 months of therapeutic penetrating keratoplasty, recurrence and inflammation have not been reported and partial corneal stitch out was done with clear cornea graft.

Reference

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