Front Cell Infect Microbiol. 2026 Jun 1;16:1805428. doi: 10.3389/fcimb.2026.1805428. eCollection 2026.
ABSTRACT
BACKGROUND: Purpureocillium lilacinum (P. lilacinum) is an emerging pathogenic fungus that can cause fungal keratitis and endophthalmitis, which pose a severe threat to patients' visual acuity.
METHODS: A retrospective analysis was conducted on 20 cases (17 keratitis and 3 endophthalmitis) caused by P. lilacinum. Clinical manifestations, mycological findings, in vitro antifungal susceptibility, treatment regimens, and visual outcomes were evaluated.
RESULTS: A total of 20 patients with unilateral P. lilacinum ocular infections were enrolled. Among these 20 cases, 14 had a clear history of trauma, including 12 cases of plant-related injury and 2 cases of metallic injury. One case had a history of pepper powder exposure to the eye; one case had a history of long-term steroid eye drops after corneal transplantation; one case had allergic conjunctivitis with prolonged steroid eye drop use. No obvious predisposing cause was identified in 3 cases. Corneal scrapings/intraocular fluid or confocal microscopy revealed hyphae/spores, and fungal identification was confirmed by morphological analysis, matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS), and internal transcribed spacer (ITS) sequencing. Antifungal susceptibility testing showed high minimum inhibitory concentrations (MICs) to amphotericin B, 5-flucytosine and fluconazole; and high minimum effective concentrations (MECs) to micafungin and caspofungin, but low MICs to triazoles (voriconazole, isavuconazole, posaconazole, itraconazole). Individualized treatment regimens were administered to the 20 patients based on their conditions, including pars plana vitrectomy combined with voriconazole infusion/anterior chamber irrigation, corneal debridement combined with pharmacotherapy, intrastromal corneal injection, and conjunctival flap covering. All patients received supplementary oral voriconazole and voriconazole eye drops. The treatment course lasted 20-96 days. Except for 3 cases with hand motion (HM) visual acuity, the best-corrected visual acuity (BCVA) of the remaining cases ranged from 0.2 to 0.8 LogMAR (Logarithm of the Minimum Angle of Resolution), and the conditions of most patients were effectively controlled.
CONCLUSION: P. lilacinum is an emerging fungal pathogen that exhibits intrinsic resistance to polyene antifungal agents (amphotericin B, natamycin), while being susceptible to triazole drugs. Early microbiological diagnosis, aggressive lesion debridement, and combined drug therapy are crucial. For progressive lesions, therapeutic keratoplasty may be required. This pathogen can pose a severe threat to visual acuity, highlighting the necessity of timely intervention.
PMID:42306530 | PMC:PMC13265360 | DOI:10.3389/fcimb.2026.1805428