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Recalcitrant Paecilomyces keratitis.

Seetha Lakshmi1, Cristina Vanessa Garcia1

  • 1Department of Infectious Disease, University of South Florida, Tampa, Florida, USA.

BMJ Case Reports
|April 27, 2019
PubMed
Summary
This summary is machine-generated.

A rare fungal corneal ulcer caused by Paecilomyces species in a contact lens wearer was successfully treated with antifungal agents and surgery. Recurrence occurred after treatment cessation, necessitating prolonged therapy.

Keywords:
infectious diseasesophthalmology

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Area of Science:

  • Ophthalmology
  • Mycology

Background:

  • Corneal ulcers can lead to significant vision loss.
  • Fungal keratitis is a serious ocular infection, particularly in contact lens wearers.

Observation:

  • A 54-year-old woman presented with a 4-week corneal ulcer after contact lens use.
  • Culture identified Paecilomyces species, with associated corneal edema and hypopyon.
  • Visual acuity in the affected eye was significantly reduced to finger counting.

Findings:

  • Initial treatment involved topical/systemic antifungals and surgical intervention (intrastromal amphotericin B, conjunctival flap).
  • Near-complete resolution was achieved after 3 months, but recurrence happened 3 weeks post-therapy cessation.
  • Prolonged antifungal therapy (6 months) was reinstituted with regular monitoring.

Implications:

  • Paecilomyces species represent a challenging cause of fungal keratitis.
  • Aggressive treatment, including surgical intervention and prolonged antifungal therapy, may be necessary.
  • Close monitoring is crucial to prevent recurrence of fungal corneal ulcers.