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E. Oueghlani, E. Baglivo, K. Bouchuiguir-Wafa, C. Pournaras, D. Lew, A.B. Safran; Voriconazol: A New Therapeutic Option for Paecilomyces Lilacinus Endophthalmitis . Invest. Ophthalmol. Vis. Sci. 2003;44(13):1412.
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Purpose: Paecilomyces lilacinus (PL) is a saprophyte fungus usually found in vegetables, fruit, soil. It is a rare cause of ocular infection. As a rule, visual outcome of PL endophtalmitis is poor, patients losing vision in the affected eyes. The organism is resistant to the usually available antifungal agents such as amphotericin B and fluconazol. We report the clinical observation of a PL endophthalmitis successfully treated with voriconazol, a new triazol molecule. To our knowledge, this is the first case of PL endophtalmitis ever treated with this new triazol antifungal agent. Methods: A 61 years old woman was referred for progressive visual loss and pain in the right eye (RE). Symptoms appeared 9 days after a secondary IOL (Artisan ®) implantation. Ophthalmological examination showed 20/200 visual acuity in the RE, a perikeratic circle, severe anterior chamber inflammation and mild vitreous inflammation. Results: A diagnosis of bacterial endophthalmitis was presumed, and the patient received imipenem and ofloxacin intraveinously in association with intra-vitreal injections of vancomicin and ceftazidim, and topical administration of garamicin and ofloxacin. Vitreous and aqueous humor cultures were negative for both fungi and either aerobes or anaerobes bacteria. A slight clinical improvement allowed the interruption of the intravenous and intravitreal antibiotical therapy. One month later, a second episode of endophtalmitis appeared (RE), vitreous cultures were performed again and then demonstrated the presence of PL. The fungigram for PL showed that fungi were resistant to amphotericin B ( MIC > 16 µg/ml), moderately susceptible to itraconazole (MIC 0.5 µg/ml) and susceptible to voriconazole (MIC 0.25 µg/ml). The patient was then treated, orally, with voriconazole 400mg, biq, for 4 months. Four months after the onset of voriconazol treatment, RE visual acuity had improved to 20/50. Conclusions: This observation emphasizes that PL endophthalmitis must be considered in post-surgical inflammation resistant to a regular antibacterial/antifungal therapy. Voriconazole, a new triazole antifungal molecule, appears to be efficient in such cases.
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