Medical management of suspected Paecilomyces sp. deep keratitis

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 ne...

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Bibliographic Details
Published in:BMJ case reports 2015-07, Vol.2015, p.bcr2015210407
Main Authors: Holland, Lee, Lee, Graham A
Format: Article
Language:English
Subjects:
Administration, Oral
Administration, Topical
Aged
Antifungal Agents - administration & dosage
Australasia
Australia
Cornea
Defects
Eye Infections, Fungal - diagnosis
Eye Infections, Fungal - drug therapy
Eye Infections, Fungal - physiopathology
Female
Hospitals
Humans
Injections
Keratitis - diagnosis
Keratitis - drug therapy
Keratitis - physiopathology
Novel Treatment (New Drug/Intervention
Established Drug/Procedure in New Situation)
Paecilomyces - isolation & purification
Treatment Outcome
Voriconazole - administration & dosage
White
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Summary: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.
ISSN:1757-790X
1757-790X
DOI:10.1136/bcr-2015-210407