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Voriconazole shows promise in treating Paecilomyces lilacinus keratitis

Am J Ophthalmol. 2009;147(4):691-696.

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Paecilomyces lilacinus keratitis commonly requires therapeutic keratoplasty but may be treated with topical antifungal agents such as voriconazole, according to a study.

P. lilacinus, a fungal pathogen that infects corneal tissue through filamentous invasion and occasional intrastromal sporulation, is not known to be treatable by natamycin or amphotericin B, the study authors said.

The observational case series included 17 eyes of 17 patients with laboratory-confirmed P. lilacinus keratitis and 25 previously reported cases.

Among the 42 cases, 13 were associated with chronic keratopathy or previous ocular surgery, 11 occurred after corneal trauma and 10 were found in soft contact lens wearers.

Results showed a medical cure occurring in 13 eyes; 29 eyes underwent penetrating keratoplasty or other procedures.

"In vitro testing of P. lilacinus indicated resistance to natamycin and amphotericin B but susceptibility to ketoconazole and voriconazole," the authors said. "Experimental inoculation after superficial scarification established moderately severe corneal paecilomycosis by hyphae and conidia in immunosuppressed mice and in explanted donor corneas."