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Posaconazole in the treatment of refractory Purpureocillium lilacinum (former Paecilomyces lilacinus) keratitis: the salvation when nothing works
  1. Mariana Almeida Oliveira1,
  2. Analia Carmo2,
  3. Andreia Rosa1,3 and
  4. Joaquim Murta1,3
  1. 1 Department of Ophthalmology, Centro Hospitalar e Universitario de Coimbra EPE, Coimbra, Portugal
  2. 2 Clinical Pathology, Centro Hospitalar e Universitario de Coimbra EPE, Coimbra, Portugal
  3. 3 Faculdade de Medicina da Universidade de Coimbra, Coimbra, Portugal
  1. Correspondence to Dr Mariana Almeida Oliveira, mariana.alg.oliveira{at}


We report a case of a 41-year-old woman, wearer of contact lenses who was presented to the emergency room with a 2-month history of pain and red eye. She presented with a severe keratitis refractory to quinolones, fortified antibiotics and clotrimazole. Due to the risk of perforation, a tectonic penetrating keratoplasty (PK) was performed. Clinical signs of keratitis recurrence were observed and cultures were positive for Purpureocillium lilacinum (former Paecilomyces lilacinus). The patient did not improve on topical amphotericin B and intracameral voriconazole. Worsening of clinical condition required a new PK. Oral posaconazole was initiated postoperatively and suspended at the fourth postoperative month. The cornea remains clear until the last follow-up visit, 12 months after the second graft. To our knowledge, this is the second case report that documents the effectiveness of oral posaconazole in a refractory P. lilacinus keratitis, resistant to other second-generation triazoles and conventional antifungals.

  • eye
  • drugs: infectious diseases
  • anterior chamber
  • unwanted effects/adverse reactions
  • transplantation
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  • Contributors MAO wrote the manuscript, took clinical pictures and assessed the surgeries and follow up of the patient. AR decided the treatment, performed the surgeries as main surgeon and supported the writing of the manuscript. AC performed the microbiological analysis and wrote the clinical pathology contents of the manuscript. JM supervised all the preparation of the manuscript. All authors discussed the results and commented on the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Not required.

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