Successful Medical Treatment of a Case of Paecilomyces lilacinus Keratitis

PURPOSE:To report a successful medical treatment of a case of keratitis caused by Paecilomyces lilacinus. METHODS:A 68-year-old woman developed an infection of the left cornea after minor trauma. The causative organism was found to be a particularly virulent organism, P. lilacinus. The patient was initially treated with natamycin topically and itraconazole orally, but the organism was resistant and failed to respond. She was then switched to topical voriconazole and oral terbinafine. RESULTS:The patient was successfully treated with these medications without surgical intervention, an unusual outcome for this organism. CONCLUSIONS:If one encounters a case of fungal keratitis that fails to respond to the more commonly used agents, one should suspect a resistant organism such as Paecilomyces and should switch to voriconazole and/or terbinafine both topically and orally.