Recalcitrant Beauveria bassiana keratitis: confocal microscopy findings and treatment with posaconazole (Noxafil).
OBJECTIVE
To report the clinical, confocal microscopic, and histologic appearance of a case of Beauveria bassiana keratitis and response to medical therapy.


METHODS
A 58-year-old woman with a 1-month history of a recalcitrant contact lens-related corneal ulcer was evaluated by confocal microscopy and corneal scraping for histology and culture.


RESULTS
Confocal microscopy and histology revealed a filamentous fungal keratitis confirmed by culture as B. bassiana resistant to amphotericin B. The keratitis was unresponsive to multiple topical and systemic antifungals but resolved after the addition of oral posaconazole.


CONCLUSIONS
B. bassiana is a rare cause of keratitis that may show significant resistance to topical and systemic antifungals but was treated successfully with the addition of oral posaconazole to topical voriconazole. Confocal microscopy and corneal smears may be of benefit in identifying and directing therapy for this slow-growing fungus.
Tu
Elmer Y
EY
Department of Ophthalmology, University of Illinois at Chicago, Chicago, IL, USA.
Park
Anna J
AJ
D000284:Administration, Oral; D000287:Administration, Topical; D000935:Antifungal Agents / Q000627:therapeutic use*; D052982:Beauveria / Q000302:isolation & purification*; D003315:Cornea / Q000382:microbiology*; D003320:Corneal Ulcer / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D004359:Drug Therapy, Combination; D015821:Eye Infections, Fungal / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology; D005260:Female; D006801:Humans; D018613:Microscopy, Confocal; D008875:Middle Aged; D009181:Mycoses / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology; D011743:Pyrimidines / Q000627:therapeutic use; D014230:Triazoles / Q000627:therapeutic use*; D065819:Voriconazole
D000935:Antifungal Agents; D011743:Pyrimidines; D014230:Triazoles; C101425:posaconazole; D065819:Voriconazole