Retrospective case-series of Paecilomyces lilacinus ocular mycoses in Queensland, Australia, 2000-2023

Abstract

Purpose: (i) To update a previous case-series of Paecilomyces lilacinus infections with a further 15 cases since 2015; (ii) to present the varied clinical manifestations of Paecilomyces lilacinus ocular mycoses; (iii) to identify risk factors and exposure events associated with disease onset; (iv) to discuss treatment regimens/surgery utilised; (v) to determine if outcomes have improved with time given the advent of newer technologies and treatments. Methods: A retrospective case series of 36 cultureproven individuals participated, who were identified via a review of the pathology reporting system utilised in the Queensland public health system. All culture proven individuals were subjected to a systematic chart review. Results: Thirty-six culture-proven cases of Paecilomyces lilacinus ocular mycoses were identified in Queensland from 1998-2023. To date, this is the largest such caseseries pertaining to this pathogen. Immunosuppression via either systemic or topical route was the primary riskfactor identified, as in 75% of cases. 78.78% of cases had an intact epithelial surface prior to onset. 58.3% of cases had no previous ocular history. 33.33% of cases occurred following initiation of topical steroids for other ophthalmic conditions. A striking range of treatments were used, with wide variability seen across eye drop regimens. Visual outcomes remained generally poor, with 44.44% of cases resulting in a final best corrected visual acuity of HM or worse. Conclusion: Paecilomyces lilacinus is a rare but devastating cause of ophthalmic disease, mostly affecting the immunocompromised. Prognosis remains poor, owing to delayed recognition and lack of consistent and effective treatment guidelines.