title: Successful treatment of Paecilomyces lilacinus keratitis with oral posaconazole.
abstract: OBJECTIVE
  To report a case of successful medical treatment with oral posaconazole in refractory fungal keratitis caused by Paecilomyces lilacinus.
  
  
  METHODS
  Case report.
  
  
  RESULTS
  A 57-year-old male, soft contact lens wearer presented with irritation, pain, photophobia, and reduced vision. Slit-lamp examination showed a large corneal epithelial defect with a peripheral infiltrate. The patient did not improve on fortified topical antibiotics. After the diagnosis of P. lilacinus fungal keratitis, oral voriconazole and topical antifungal therapy were started. Despite antifungal therapy, progressive disease required therapeutic penetrating keratoplasty. Postoperatively, because of clinical signs of recurrence and in vivo confocal microscopy findings of presumed hyphae in the cornea, intracameral miconazole was injected and oral posaconazole was started. The patient improved and demonstrated no hyphae 6 weeks after starting posaconazole. When posaconazole was stopped, the cornea remained clear with excellent acuity. However, because of acute graft rejection 2 months after stopping posaconazole, keratoprosthesis was implanted, with no evidence of infection at surgery or during the 3.5-year follow-up.
  
  
  CONCLUSIONS
  To the best of our knowledge, this is the first report on the use of oral posaconazole for Paecilomyces keratitis. Posaconazole might be indicated in the treatment of refractory Paecilomyces keratitis that is resistant to conventional therapy.
authors.affiliation: *Ocular Surface Imaging Center, Massachusetts Eye and Ear Infirmary, Boston, MA; †Corneal and Refractive Surgery Service, Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, MA; ‡Department of Ophthalmology, Cogan Pathology Laboratory, Massachusetts Eye and Ear Infirmary, Boston, MA; and §Department of Medicine, Division of Infectious Diseases, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Arnoldner
authors.forename: Ahmad
authors.initials: A
authors.lastname: Kheirkhah
authors.forename: Frederick A
authors.initials: FA
authors.lastname: Jakobiec
authors.forename: Marlene L
authors.initials: ML
authors.lastname: Durand
authors.forename: Pedram
authors.initials: P
authors.lastname: Hamrah
mesh_terms: D000284:Administration, Oral; D000935:Antifungal Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D003320:Corneal Ulcer / Q000188:drug therapy* / Q000382:microbiology; D015821:Eye Infections, Fungal / Q000188:drug therapy* / Q000382:microbiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000188:drug therapy* / Q000382:microbiology; D010143:Paecilomyces / Q000302:isolation & purification*; D014230:Triazoles / Q000008:administration & dosage / Q000627:therapeutic use*
chemical_list: D000935:Antifungal Agents; D014230:Triazoles; C101425:posaconazole