TY - JOUR T1 - Posaconazole in the treatment of refractory <em>Purpureocillium lilacinum</em> (former <em>Paecilomyces lilacinus</em>) keratitis: the salvation when nothing works JF - BMJ Case Reports JO - BMJ Case Reports DO - 10.1136/bcr-2018-228645 VL - 12 IS - 4 SP - e228645 AU - Mariana Almeida Oliveira AU - Analia Carmo AU - Andreia Rosa AU - Joaquim Murta Y1 - 2019/04/01 UR - http://casereports.bmj.com/content/12/4/e228645.abstract N2 - 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. ER -