title: Purpureocillium lilacinum keratitis: a case series and review of the literature.
abstract: OBJECTIVE
  To describe the clinical features and risk factors of and optimal antifungal therapy for Purpureocillium lilacinum keratitis.
  
  
  METHODS
  Retrospective case series in a quaternary referral hospital setting.
  
  
  METHODS
  Comprehensive chart review of patients diagnosed with P. lilacinum keratitis in the past 10 years.
  
  
  METHODS
  Four patients were identified. All were aged 60 years or greater, with none having prior ocular trauma. Two had significant potential environmental exposure risks, and 3 were using systemic immunosuppressants for scleritis.
  
  
  RESULTS
  All cases received empirical treatment that included topical corticosteroids. Three were treated with combined oral, topical, and intracameral voriconazole, but developed endophthalmitis necessitating surgery with poor outcomes, including enucleation in 2. One case received combined oral and topical voriconazole with terbinafine, and maintained visual acuity without the need for surgery. All P. lilacinum isolates were susceptible to voriconazole.
  
  
  CONCLUSIONS
  P. lilacinum keratitis is rare, with the major risk factor being immunosuppression. There may be no history of ocular trauma. Microbiological diagnosis and antifungal susceptibility testing is essential. Combination synergistic antifungal therapy with topical voriconazole and oral terbinafine, with addition of systemic voriconazole if needed, results in the best outcome.
authors: Department of Infectious Diseases, Royal Brisbane and Women's Hospital, Queensland, Australia.. Electronic address: christopher.chew@doctors.org.uk.
authors: Rusheng
authors: R
authors: Chew
authors: Department of Infectious Diseases, Royal Brisbane and Women's Hospital, Queensland, Australia.
authors: Andrew
authors: A
authors: Dorman
authors: Department of Infectious Diseases, Royal Brisbane and Women's Hospital, Queensland, Australia.
authors: Marion L
authors: ML
authors: Woods
mesh_terms: D000368:Aged; D000935:Antifungal Agents / Q000627:therapeutic use; D003320:Corneal Ulcer / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D015821:Eye Infections, Fungal / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D010143:Paecilomyces / Q000302:isolation & purification*; D012017:Referral and Consultation; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D000935:Antifungal Agents; D005938:Glucocorticoids