Atlas of Ophthalmology

Paecilomyces lilacinus Keratitis with Secondary Fungous Endophthalmitis (Colour photography, Ultrasound)

Cornea -> Keratitis, Infectious/ Non-Infectious
Patient: 84 years of age, female General Medical History: empty. Ocular Medical History: since two weeks she observed a white spot at the cornea. Paecilomyces was isolated from a vitreous aspirate. Despite antifungal therapy with voriconazole an enucleation of the eye could not be avoided. Main Complaint: deterioration of visual acuity. Purpose: to present a case of Paecilomyces lilacinus keratitis with secondary fungous endophthalmitis requiring enucleation of the eye. Methods: Colour photography, ultrasound. Findings: Colour photography: corneal infiltrate with retrocorneal mycel from 5.12.2013 and from 10.12.2013. Ultrasound: vitreous infiltration indicating fungous endophthalmitis. Discussion: Paecilomyces is a rare cause of keratitis, but is an emerging fungal pathogen that infects corneal tissue by filamentous invasion with occasional intrastromal sporulation. The infection is difficult to eradicate because of multiple antifungal drug resistance and has a poor outcome. Yuan et al . (1) described the pathogenesis and outcome of Paecilomyces keratitis. He found, that of 42 reported eyes with Paecilomyces keratitis, 31% were associated with chronic keratopathy or previous ocular surgery, 26% followed corneal trauma, and 24% occurred in soft contact lens wearers. In vitro testing indicated resistance to natamycin and amphotericin B but susceptibility to ketoconazole and voriconazole. The study stated, that Paecilomyces keratitis does not reliably respond to natamycin or amphotericin B and has often required therapeutic keratoplasty, but topical azole antifungal agents such as voriconazole appear promising. Literature: (1) Yuan X, Wilhelmus KR, Matoba AY, Alexandrakis G, Miller D, Huang AJ. Pathogenesis and outcome of Paecilomyces keratitis. Am J Ophthalmol. 2009 Apr;147(4):691-696

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