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Management of recurrent Paecilomyces lilacinus keratitis

Cameron A McLintock1, Graham A Lee, Graeme Atkinson

  • 1Royal Brisbane and Women's Hospital, Herston, Queensland, Australia.

Clinical & Experimental Optometry
|August 29, 2012
PubMed

Insights

A rare fungal eye infection, Paecilomyces keratitis, occurred in an immunosuppressed patient. Aggressive treatment, including multiple surgeries and voriconazole, ultimately cleared the infection after 16 months.

Area of Science:

  • Ophthalmology
  • Mycology

Background:

  • Fungal keratitis poses a significant threat to vision, particularly in immunocompromised individuals.
  • Paecilomyces species are emerging pathogens causing severe ocular infections.

Observation:

  • A 72-year-old male developed Paecilomyces keratitis following immunosuppressive therapy.
  • The infection led to corneal perforation requiring tectonic keratoplasty and recurrent stromal infiltration despite voriconazole treatment.
  • Further complications included lens capsule fungal infiltration, hypopyon, and endophthalmitis, necessitating multiple surgical interventions.

Findings:

  • Aggressive and prolonged treatment with voriconazole (oral, topical, intracameral, and intravitreal) combined with surgical management (keratoplasty, phacoemulsification, vitrectomy) eventually eradicated the Paecilomyces infection.
  • The patient achieved infection resolution at 16 months post-recurrence.
  • Long-term sequelae included a sutured intraocular lens and artificial iris, with a final unaided visual acuity of 6/36.

Implications:

  • This case highlights the challenges in managing severe Paecilomyces keratitis in immunosuppressed patients.
  • It underscores the importance of a multi-modal treatment approach involving aggressive antifungal therapy and surgical intervention.
  • Successful management can be achieved even in complex, recurrent cases, albeit with potential long-term visual impairment.

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