title: Fungal keratitis caused by Paecilomyces lilacinus associated with a retained intracorneal hair.
abstract: OBJECTIVE
  To report a case of fungal keratitis caused by Paecilomyces lilacinus (P. lilacinus) associated with a retained intracorneal hair.
  
  
  METHODS
  A 61-year-old man developed pain, decreased vision, hyperemia, and corneal infiltrates in his right eye without any predisposing factor. An intracorneal hair had migrated superiorly in the corneal stroma, giving rise to 3 separate stromal infiltrates. The patient demonstrated a waxing and waning course over several months despite antimicrobial and steroid therapy.
  
  
  RESULTS
  Histopathologic examination of a corneal biopsy specimen disclosed the presence of fungal elements, and intensive antifungal therapy was initiated. Verticillium sp. was initially identified as the causative organism, but after failure to improve on topical natamycin, subsequent investigations demonstrated the pathogen to be P. lilacinus that was resistant to routine antifungal agents. The patient was then initiated on systemic voriconazole and terbinafine. He responded well to treatment and ultimately recovered a best-corrected visual acuity of 6/15 in the affected eye.
  
  
  CONCLUSIONS
  This is the first case of P. lilacinus keratitis associated with a retained intracorneal hair. Hair in the cornea could be a predisposing factor for this infection. Early corneal biopsy should be considered to properly diagnose and manage atypical keratitis and to prevent further complications.
authors.affiliation: Department of Ophthalmology and Centre for Eye Research Australia, The University of Melbourne, The Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia. ka_anderson@msn.com
authors.forename: Kent L
authors.initials: KL
authors.lastname: Anderson
authors.forename: Sandip
authors.initials: S
authors.lastname: Mitra
authors.forename: Ramin
authors.initials: R
authors.lastname: Salouti
authors.forename: Thu-Anh
authors.initials: TA
authors.lastname: Pham
authors.forename: Hugh R
authors.initials: HR
authors.lastname: Taylor
mesh_terms: D000900:Anti-Bacterial Agents; D000935:Antifungal Agents / Q000627:therapeutic use; D003319:Corneal Stroma / Q000382:microbiology; D003320:Corneal Ulcer / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D004359:Drug Therapy, Combination / Q000627:therapeutic use; D005129:Eye Foreign Bodies / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D015821:Eye Infections, Fungal / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D005548:Foreign-Body Migration / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D006197:Hair; D006801:Humans; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D009281:Naphthalenes / Q000627:therapeutic use; D010143:Paecilomyces / Q000302:isolation & purification*; D011743:Pyrimidines / Q000627:therapeutic use; D000077291:Terbinafine; D014230:Triazoles / Q000627:therapeutic use; D065819:Voriconazole
chemical_list: D000900:Anti-Bacterial Agents; D000935:Antifungal Agents; D009281:Naphthalenes; D011743:Pyrimidines; D014230:Triazoles; D000077291:Terbinafine; D065819:Voriconazole