The successful medical treatment of a case of paecilomyces lilacinus keratitis

Purpose: To report the successful medical treatment of Paecilomyces lilacinus keratitis case with topical voriconazole. Methods: A 72-year-old male farmer developed a corneal infection in the left eye and corneal culture revealed Paecilomyces lilacinus. Infection was progressive despite initial treatment with hourly topical amphotericin B (1.5 mg/mL) and topical 5% natamycin. Treatment was switched to hourly topical voriconazole (10 mg/mL). Results: The infection responded well to topical voriconazole and resolved within 1 month without any surgical intervention. The patient's best-corrected visual acuity was 20/200 secondary to central corneal scarring and a cataract in the left eye at the 10-month follow-up. Conclusion: Voriconazole may be effective in the treatment of Paecilomyces lilacinus keratitis refractory to standard antifungal agents. Early organism detection and appropriate treatment are necessary to eradicate such an infection.