Successful treatment of Paecilomyces lilacinus endophthalmitis after foreign body trauma to the cornea

Purpose. To report the successful treatment of a patient with Paecilomyces lilacinus endophthalmitis infection after foreign body (FB) trauma to the c ornea. Methods. A 30-year-old man presented to us with a corneal abscess an d iritis 2 months after removal of a metal corneal FB. Initial corneal biop sy culture was negative. Treatment with topical 5% natamycin, 0.9% fortifie d gentamycin, and 5% cephalothin hourly was commenced. As a result of devel oping signs of endophthalmitis, two more biopsies were taken, a week apart, from the vitreous and anterior chamber, successively. The last biopsy yiel ded positive microbiologic results of the specious Paecilomyces lilacinus. Intravitreal injection of 50 mug/0.5 mL of amphotericin was administered du ring the vitreal biopsy. Soon after isolating the specious Paecilomyces lil acinus, the following treatment was administered: 200 mg of itraconazole bd by mouth, 5% topical natamycin every hour, 2 mg/mL of topical fluconazole every 2 hours, three anterior chamber injections of 0.35 mL of 0.1% flucona zole and two amphotericin B injections to the anterior chamber of 50 mug/0. 5 mL each. Results. There appeared to be no sign of infection 6 months afte r initial treatment. A large, dense scar existed in the medial part of the cornea only. The pupil was secluded. The patient's visual acuity was 6/21. The eye was comfortable and all topical antifungal medication was ceased.