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Three cases of recalcitrant Paecilomyces keratitis in Southern California within a short period
Christine K Kim1, Joseph T Mekhail2, David M Morcos2
1Gavin Herbert Eye Institute, University of California, Irvine School of Medicine, 850 Health Sciences Rd, Irvine, CA, 92617, USA. Chriskk4@hs.uci.edu.
Background:
The aim of this report is to describe the risk factors, clinical course, and characteristics of three cases of Paecilomyces keratitis presenting concurrently within three months in the same location. We used in vivo confocal microscopy and histopathology to corroborate our clinical findings.
Observations:
Three eyes of three elderly patients with culture-proven Paecilomyces keratitis were included in this series. These patients resided within a 15-mile radius and presented to a tertiary care eye institute in Southern California between February and April 2022. All three eyes experienced a prolonged, recalcitrant course with recurrence of keratitis in donor corneal tissue despite antifungal therapy and multiple therapeutic penetrating keratoplasties. In vivo confocal microscopy, histopathology, and microbiologic findings corroborated the diagnosis of fungal keratitis with Paecilomyces. With surgical intervention and extensive medical therapy, all three cases resolved after the addition of oral Posaconazole.
Conclusions:
Paecilomyces is a rare cause of infectious keratitis. Herein we report three similar cases in elderly patients. All had prolonged, recalcitrant infections that required multiple treatment modalities. Our cases, which were supported by in vivo confocal microscopy and histopathology, highlight the importance of timely and aggressive therapy to prevent recurrence.
Insights
Three elderly patients experienced severe Paecilomyces keratitis, a rare fungal infection. Aggressive treatment, including oral posaconazole, was crucial for resolving these persistent corneal infections.
Area of Science:
- Ophthalmology
- Mycology
- Infectious Diseases
Background:
- Paecilomyces keratitis is a rare fungal infection of the cornea.
- Three concurrent cases of Paecilomyces keratitis occurred in elderly patients within a localized area.
- The study investigates risk factors, clinical course, and characteristics of these infections.
Purpose of the Study:
- To describe the clinical presentation and management of three concurrent cases of Paecilomyces keratitis.
- To highlight the challenges in treating this rare fungal keratitis.
- To emphasize the importance of timely and aggressive therapeutic interventions.
Main Methods:
- Case series of three elderly patients with culture-proven Paecilomyces keratitis.
- Utilized in vivo confocal microscopy and histopathology for diagnosis.
- Documented clinical course, treatment modalities, and outcomes.
Main Results:
- All three patients presented with prolonged and recalcitrant keratitis, with recurrence in donor corneal tissue.
- Infections persisted despite antifungal therapy and multiple keratoplasties.
- Resolution was achieved with surgical intervention, extensive medical therapy, and oral posaconazole.
Conclusions:
- Paecilomyces keratitis is a rare but challenging fungal infection.
- Elderly patients with this condition may experience prolonged and recurrent infections.
- Prompt and aggressive treatment, including novel antifungal agents like posaconazole, is vital for successful outcomes.
