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Posaconazole in the treatment of refractory Purpureocillium lilacinum (former Paecilomyces lilacinus ) keratitis: the salvation when nothing works

2019; BMJ; Volume: 12; Issue: 4 Linguagem: Inglês

10.1136/bcr-2018-228645

1757-790X

Mariana Almeida Oliveira, Anália do Carmo, Andreia Rosa, Joaquim Murta,

Antifungal resistance and susceptibility

We report a case of a 41-year-old woman, wearer of contact lenses who was presented to the emergency room with a 2-month history of pain and red eye. She presented with a severe keratitis refractory to quinolones, fortified antibiotics and clotrimazole. Due to the risk of perforation, a tectonic penetrating keratoplasty (PK) was performed. Clinical signs of keratitis recurrence were observed and cultures were positive for Purpureocillium lilacinum ( former Paecilomyces lilacinus) . The patient did not improve on topical amphotericin B and intracameral voriconazole. Worsening of clinical condition required a new PK. Oral posaconazole was initiated postoperatively and suspended at the fourth postoperative month. The cornea remains clear until the last follow-up visit, 12 months after the second graft. To our knowledge, this is the second case report that documents the effectiveness of oral posaconazole in a refractory P. lilacinus keratitis, resistant to other second-generation triazoles and conventional antifungals.