Successful treatment of Paecilomyces lilacinus endophthalmitis after foreign body trauma to the cornea.
OBJECTIVE
To report the successful treatment of a patient with Paecilomyces lilacinus endophthalmitis infection after foreign body (FB) trauma to the cornea.


METHODS
A 30-year-old man presented to us with a corneal abscess and iritis 2 months after removal of a metal corneal FB. Initial corneal biopsy culture was negative. Treatment with topical 5% natamycin, 0.9% fortified gentamycin, and 5% cephalothin hourly was commenced. As a result of developing signs of endophthalmitis, two more biopsies were taken, a week apart, from the vitreous and anterior chamber, successively. The last biopsy yielded positive microbiologic results of the specious Paecilomyces lilacinus. Intravitreal injection of 50 microg/0.5 mL of amphotericin was administered during the vitreal biopsy. Soon after isolating the specious Paecilomyces lilacinus, the following treatment was administered: 200 mg of itraconazole bd by mouth, 5% topical natamycin every hour, 2 mg/mL of topical fluconazole every 2 hours, three anterior chamber injections of 0.35 mL of 0.1% fluconazole and two amphotericin B injections to the anterior chamber of 50 microg/0.5 mL each.


RESULTS
There appeared to be no sign of infection 6 months after initial treatment. A large, dense scar existed in the medial part of the cornea only. The pupil was secluded. The patient's visual acuity was 6/21. The eye was comfortable and all topical antifungal medication was ceased.
Domniz
Y
Y
The Eye Institute, Chatswood, Australia.
Lawless
M
M
Sutton
G L
GL
Rogers
C M
CM
Meagher
L J
LJ
D000328:Adult; D000867:Anterior Chamber / Q000382:microbiology / Q000473:pathology; D000935:Antifungal Agents / Q000008:administration & dosage*; D001706:Biopsy; D003315:Cornea / Q000473:pathology; D065306:Corneal Injuries; D003937:Diagnosis, Differential; D004359:Drug Therapy, Combination; D009877:Endophthalmitis / Q000188:drug therapy* / Q000209:etiology / Q000382:microbiology / Q000473:pathology; D005129:Eye Foreign Bodies / Q000150:complications*; D015821:Eye Infections, Fungal / Q000188:drug therapy / Q000382:microbiology / Q000473:pathology; D006801:Humans; D007267:Injections; D008297:Male; D009181:Mycoses / Q000188:drug therapy* / Q000382:microbiology / Q000473:pathology; D010143:Paecilomyces / Q000302:isolation & purification*; D014792:Visual Acuity; D014822:Vitreous Body / Q000382:microbiology / Q000473:pathology; D014946:Wound Infection / Q000188:drug therapy* / Q000382:microbiology / Q000473:pathology
D000935:Antifungal Agents