Chew Rusheng, Dorman Andrew, Woods Marion L
Department of Infectious Diseases, Royal Brisbane and Women's Hospital, Queensland, Australia..
Department of Infectious Diseases, Royal Brisbane and Women's Hospital, Queensland, Australia.
Can J Ophthalmol. 2016 Oct;51(5):382-385. doi: 10.1016/j.jcjo.2016.05.013. Epub 2016 Sep 3.
To describe the clinical features and risk factors of and optimal antifungal therapy for Purpureocillium lilacinum keratitis.
Retrospective case series in a quaternary referral hospital setting.
Comprehensive chart review of patients diagnosed with P. lilacinum keratitis in the past 10 years.
Four patients were identified. All were aged 60 years or greater, with none having prior ocular trauma. Two had significant potential environmental exposure risks, and 3 were using systemic immunosuppressants for scleritis.
All cases received empirical treatment that included topical corticosteroids. Three were treated with combined oral, topical, and intracameral voriconazole, but developed endophthalmitis necessitating surgery with poor outcomes, including enucleation in 2. One case received combined oral and topical voriconazole with terbinafine, and maintained visual acuity without the need for surgery. All P. lilacinum isolates were susceptible to voriconazole.
P. lilacinum keratitis is rare, with the major risk factor being immunosuppression. There may be no history of ocular trauma. Microbiological diagnosis and antifungal susceptibility testing is essential. Combination synergistic antifungal therapy with topical voriconazole and oral terbinafine, with addition of systemic voriconazole if needed, results in the best outcome.
描述淡紫拟青霉角膜炎的临床特征、危险因素及最佳抗真菌治疗方法。
在一家四级转诊医院环境中的回顾性病例系列研究。
对过去10年中诊断为淡紫拟青霉角膜炎的患者进行全面病历回顾。
共确定4例患者。所有患者年龄均在60岁及以上，均无眼部外伤史。2例有明显的潜在环境暴露风险，3例因巩膜炎正在使用全身免疫抑制剂。
所有病例均接受了包括局部使用皮质类固醇的经验性治疗。3例接受口服、局部及前房内注射伏立康唑联合治疗，但发生了眼内炎，需要手术治疗，预后较差，其中2例眼球摘除。1例接受口服和局部伏立康唑联合特比萘芬治疗，视力得以维持，无需手术。所有分离出的淡紫拟青霉对伏立康唑均敏感。
淡紫拟青霉角膜炎罕见，主要危险因素为免疫抑制。可能无眼部外伤史。微生物学诊断和抗真菌药敏试验至关重要。局部伏立康唑和口服特比萘芬联合协同抗真菌治疗，必要时加用全身伏立康唑，可取得最佳疗效。
