title: Medical management of suspected Paecilomyces sp. deep keratitis.
abstract: A 74-year-old woman developed a deep keratitis presenting with an endothelial plaque without overlying stromal involvement. Owing to the characteristic clinical appearance, she was provisionally diagnosed with a Paecilomyces sp. keratitis. Corneal scrapings and aqueous humour samples were culture negative. The difficulties in diagnosing Paecilomyces sp. keratitis are discussed. The patient's keratitis was managed with a combination of topical, oral and intracameral injections of voriconazole. This medical management strategy was successful in achieving good infection control and visual outcome. We report a rarely encountered presentation of keratitis in which the clinical appearance and response to voriconazole are highly suggestive evidence of a Paecilomyces sp. keratitis. We believe the combination of topical, oral and intracameral injections of voriconazole represents a novel treatment approach for Paecilomyces sp. keratitis. Our case supports the potential for a medical approach as initial treatment in this otherwise devastating form of oculomycosis.
authors.affiliation: Department of Ophthalmology, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.
authors.forename: Lee
authors.identifier: http://orcid.org/0000-0002-2705-0003
authors.initials: L
authors.lastname: Holland
authors.affiliation: Department of Ophthalmology, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia City Eye Centre, Brisbane, Queensland, Australia.
authors.forename: Graham A
authors.initials: GA
authors.lastname: Lee
mesh_terms: D000284:Administration, Oral; D000287:Administration, Topical; D000368:Aged; D000935:Antifungal Agents / Q000008:administration & dosage*; D001315:Australia; D015821:Eye Infections, Fungal / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology; D005260:Female; D006801:Humans; D007634:Keratitis / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology; D010143:Paecilomyces / Q000302:isolation & purification*; D016896:Treatment Outcome; D065819:Voriconazole / Q000008:administration & dosage*
chemical_list: D000935:Antifungal Agents; D065819:Voriconazole