Table 1 Cases
From: Retrospective case-series of Paecilomyces lilacinus ocular mycoses in Queensland, Australia
Case/identified (year) | Site | Presentation | Immunosuppression/risk factor | Specimen | Past ocular history | Comorbidities | Treatment |
|---|---|---|---|---|---|---|---|
1 (2000) | PAH | Hypopyon | Suspected trauma + PO + topical steroids | Corneal biopsy/aqueous fluid | 6 months prior biopsy of sclera taken for lesion—showed chronic inflammation lead to treatment with topical and PO steroids | Nil | AC tap × 3 + corneal biopsy. IV amphotericin + topical natomycin. Intracameral amphotericin × 4. Enucleation |
2 (2001) | RBWH | Endophthalmitis | PO prednisolone, cyclophosamide, methotrexate | Vitreous fluid | 11 months prior treated for anterior necrotizing scleritis. Subsequently developed endophthalmitis | Nil | Vitreous tap performed. Commenced topical natomycin, PO itraconazole, and PPV/AC washout/intravitreal amphotericin. Intravitreal × 4 amphotericin + IV. PO voriconazole. Enucleation |
3 (2001) | RBWH | AC and anterior vitreous inflammation | PO steroids | Vitreous fluid | Nil | Ulcerative colitis | Presumed inflammatory secondary to underlying autoimmune illness. Treated with 2 weeks of topical steroids prior to referral. PPV/vitreous biopsy/intravitreal amphotericin/ceftazadime/vancomycin + IV of all three. 2 × further intravitreal amphotericin. Repeat PPV/intravitreal amphotericin + vancomycin |
4 (2002) | PAH | AC and anterior vitreous inflammation | Topical + PO steroids. Park tractor mower operator | Vitreous fluid | Nil | Nil | AC tap performed. Commenced IV, intravitreal and topical amphotericin. PPV/lensectomy/intravitreal amphotericin. PO voriconazole. Repeat PPV/Intravitreal amphotericin. PK/iridectomy/washout/amphotericin |
5 (2002) | PAH | Deep stromal infiltrate | Vegetative matter versus eye + topical steroids | Aqueous fluid | Nil | Nil | FB versus eye. Treated with topical steroids + antibiotics. Proceeded to develop deep stromal infiltrate. Presumed fungal keratitis. Corneal scrape + AC tap. Commenced topical natamycin + amphotericin and PO itraconazole. Multiple repeat cultures (corneal biopsy × 2). IV amphotericin + PO voriconazole. PK |
6 (2002) | PAH | Endothelial plaque 2.4 mm × 1.8 mm | Nil | Vitreous fluid | Nil | Nil | Aqueous tap showed fungal hyphae. Natamycin topical, itraconazole PO + amphotericin IV commenced. PK/lamellar sclerotomy/iridectomy. Recurrence lead to PPV/iridectomy/lensectomy/intravitreal amphotericin. Amphotericin topical and voriconazole PO |
7 (2002) | PAH | Anterior chamber reaction | Nil | Vitreous fluid | Nil | Nil | Red painful eye plus AC reaction. Steroid challenge. Deteriorated to endothelial change. Corneal biopsy. PK. IV amphotericin. PPV/lensectomy/iridectomy/intravitreal amphotericin. Repeat PK. PO voriconazole |
8 (2004) | PAH | Interstitial keratitis | Metal worker + topical and PO steroids | Corneal biopsy | Nil | Nil | AC tap. Topical natomycin + PO itraconazole. Corneal biopsy. Topical voriconazole. PK/iridectomy. Topical + PO voriconazole |
9 (2004) | RBWH | Keratitis | Vegetative matter versus eye | Corneal scrape | Nil | Nil | Corneal scrape. Treated with topical gentamicin and ceftazidime. Improved without antifungals |
10 (2004) | PAH | Keratoscleritis | Nil | Corneal biopsy | Nil | Nil | Topical natomycin. PO fluconazole + voriconazole. Corneoscleral graft/anterior vitrectomy |
11 (2006) | PAH | Deep stromal infiltrate | Topical steroids | Aqueous fluid | Seen by multiple ophthalmologists. Red, painful eye treated with topical steroids | Nil | Developed deep stromal infiltrate with no epithelial defect. Corneal scrape. Commenced on PO and topical voriconazole. AC Tap. Repeat Corneal scrape. Corneal biopsy 3 mm. Corneoscleral graft/AC voriconazole. Topical natomycin. Phaco/IOL |
12 (2008) | PAH | Scleritis | Topical + PO prednisolone + PO cyclophosamide | Corneal biopsy | Bisphosphonate scleritis | Osteoporosis | Voriconazole PO + topical + corneal biopsy and aqueous tap. Amphotericin intracameral. PK + intracameral amphotericin. 3 × PKs, 1 corneoscleral graft/iridectomy/lensectomy. 15 × intracameral voriconazole. Enucleation |
13 (2008) | PAH | FB (grass tree) to eye | Topical steroids | Corneal biopsy | Bilateral pseudophakic | Nil | Initially treated with topical ofloxacin post FB (improved). Topical steroids commenced lead to worsening of symptoms. AC tap, repeat AC tap and corneal scrape. Voriconazole PO, topical and intracameral. PK + intracameral voriconazole. Repeat PK + IV, intracameral, intravitreal amphotericin, PO terbinafine and topical natomycin added |
14 (2009) | RBWH | Vitritis? Toxoplasmosis | Nil | Vitreous fluid | Nil | Nil | Vitreous Tap × 2. Second showed filamentous fungi. Topical, intravitreal × 2, PO voriconazole + PO terbinafine. PPV/intravitreal amphotericin |
15 (2009) | RBWH | Vitritis? Toxoplasmosis | Works with organic matter | Vitreous/aqueous fluid | Bilateral pseudophakic. Right RRD (Buckled). 4 months prior diagnosed with Toxoplasmosis. Treated with PO pyrimethamine + sulfadiazine | Nil | Relapse lead to vitreous tap + intravitreal ceftazadime/vancomycin/triamcinolone. 5 × intravitreal, topical + PO voriconazole. 2 × PPV |
16 (2009) | RBWH | Presumed contact lens associated microbial keratitis | Contact lens wearer | Corneal scrape | Myope | Nil | Corneal scrape performed. Fungal hyphae identified. Topical voriconazole |
17 (2009) | PAH | Pseudomonas contact lens associated keratitis | Contact lens wearer, topical steroids | Corneal scrape | 2-month prior treated successfully for culture positive pseudomonas contact lens associated microbial keratitis. Topical steroids commenced lead to worsening of symptoms | Nil | Corneal scrape + AC tap. Fungal elements identified. Topical natamycin + voriconazole topical and PO. PK + intracameral voriconazole. 7 × intracameral voriconazole. PO terbinafine + posaconazole (due to LFT derangement by voriconazole). Glaucoma—cyclodiode × 2. Cataract extraction |
18 (2009) | PAH | Acute anterior uveitis | Sulfasalazine, azathioprine | Vitreous fluid | Nodular episcleritis treated 6 month earlier with topical FML and Prednefrin forte | Crohn’s disease | Presented with AC inflammation treated with topical Prednefrin forte. Did not improve lead to vitreous tap. Fungal elements seen on tap. PO voriconazole. PPV + intravitreal voriconazole, amphotericin. Went onto have Phaco/IOL |
19 (2010) | RBWH | Keratoscleritis | PO prednisolone + topical steroid. Tropical fruit farmer | Corneal biopsy | 4 months prior treated with topical and PO steroid + PO NSAID for nodular scleritis | Nil | Progressive disease leading to corneal involvement. Infection suspected. Corneal biopsy. PO, topical voriconazole commenced. PK. Recurrence. Corneoscleral graft. Phaco/wash‐out/intracameral voriconazole. Iridectomy/PPV/intravitreal voriconazole + amphotericin. Patient underwent weekly then 2nd weekly intravitreal voriconazole for 6 months as unable to tolerate PO voriconazole. Sutured IOL with artificial iris |
20 (2012) | RBWH | Keratitis | Topical steroid | Corneal biopsy/aqueous fluid | 2 months prior treated for AAU. Failed to attend follow‐up | Nil | Represented with AC inflammation with deep corneal involvement. Biopsy + AC tap. PO + topical voriconazole. 8 × intracameral voriconazole. Topical natamycin |
21 (2012) | RBWH | Endophthalmitis | PO + topical steroid + cyclophosamide | Aqueous fluid | 6 months prior treated for diffuse anterior scleritis | Type 2 diabetes | Developed dense AC reaction. AC tap performed. PO + topical + intracameral × 7 voriconazole, IV amphotericin. Enucleation |