The objective of this study was to describe 2 cases of
keratitis caused by Purpureocillium lilacinum (formerly Paecilomyces lilacinus) that occurred in disposable
contact lens users, which were successfully treated with topical
voriconazole. Case 1 was a healthy 44-year-old woman, who wore weekly disposable
contact lenses and had developed a superficial corneal
infection in her right eye. For diagnosis, corneal scraping and molecular identification of the cultured pathogen were performed. A corneal smear revealed the presence of fungi. The pathogen was identified as P. lilacinum by traditional morphological identification of fungal culture, and this identification was confirmed by
DNA sequencing of the ribosomal internal transcribed spacer (ITS) sequence.
Therapy with topical
fluconazole, topical
pimaricin (
natamycin), and oral
itraconazole were ineffective. Topical
voriconazole showed a significant effect, and the
keratitis was successfully treated. Case 2 was a 43-year-old woman with bilateral recurrent peripheral corneal
ulcers by
meibomian gland dysfunction, who used therapeutic
bandage contact lenses on her left eye. However, a corneal
abscess with hypopyon occurred in the eye after 3 months. The microbial smear examination showed the presence of fungi and the fungal culture, and the DNA sequence of ITS region revealed that the causative agent was P. lilacinum. The susceptibility testing against
antifungal agents showed that
voriconazole was effective. The lesion improved gradually by topical
voriconazole. As a conclusion, P. lilacinum
keratitis can occur in disposable
soft contact lens wearer. Early and accurate detection of the pathogenic organism is essential. Topical
voriconazole was effective against P. lilacinum
keratitis.