Keratitis Caused by Paecilomyces lilacinus after Cataract Surgery in a Patient with Systemic and Autoimmune Disease.
10.3341/jkos.2016.57.11.1795
- Author:
Shin Yeop OH
1
;
Hye Sook KANG
;
Chang Kyu LEE
Author Information
1. Department of Ophthalmology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea.
- Publication Type:Case Report
- Keywords:
Fungal keratitis;
Paecilomyces lilacinus;
Penetrating keratoplasty;
Voriconazole
- MeSH:
Aged;
Amnion;
Amphotericin B;
Antifungal Agents;
Arthritis, Rheumatoid;
Autoimmune Diseases*;
Cataract*;
Corneal Edema;
Corneal Perforation;
Female;
Freezing;
Hepatitis C;
Humans;
Hyperlipidemias;
Hypertension;
Keratitis*;
Keratoplasty, Penetrating;
Natamycin;
Paecilomyces*;
Prognosis;
Recurrence;
Steroids;
Sutures;
Transplants;
Visual Acuity;
Voriconazole
- From:Journal of the Korean Ophthalmological Society
2016;57(11):1795-1800
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
PURPOSE: To report a case of Paecilomyces lilacinus fungal keratitis after cataract surgery in a patient with chronic systemic and autoimmune disease who was treated with medical therapy and penetrating keratoplasty. CASE SUMMARY: A 72-year-old female was referred for decreased visual acuity and ocular pain in the left eye. She underwent cataract surgery in the left eye 1 month earlier and was treated for 2 weeks for corneal edema and stromal infiltration around the corneal suture. She had a chronic systemic disease with hypertension, hyperlipidemia, hepatitis C and rheumatoid arthritis. Suspecting infectious keratitis, the patient was instructed to stop applying topical and systemic steroids and use topical amphotericin B (0.15%) and moxifloxacin (0.5%). However, without improvement, amphotericin B (0.15%) and moxifloxacin (0.5%) were changed to natamycin (5%) and topical voriconazole (2%) and systemic voriconazole was added. However, her systemic status deteriorated and corneal melting developed, scleral graft implantation and amniotic membrane implantation were performed to prevent corneal perforation 6 weeks after the initial visit. Paecilomyces lilacinus was identified in culture at 7 weeks and penetrating keratoplasty was performed 12 weeks after the initial visit. After penetrating keratoplasty, corneal status was stable for 6 months and no signs of recurrence were observed. CONCLUSIONS: In a patient with Paecilomyces lilacinus fungal keratitis and chronic systemic and autoimmune disease, penetrating keratoplasty showed good prognosis when the disease was refractory to topical and systemic antifungal agents.
