Purpureocillium lilacinum keratitis in a methamphetamine user: Case report

<i>Purpureocillium lilacinum</i> (PL) is an infrequent cause of fungal keratitis. Treatment of PL keratitis is complicated by delayed diagnosis, resistance to topical antifungal treatments, and the frequent need for surgical intervention. We report a case of PL keratitis in a patient with a significant history of methamphetamine use who initially presented with a persistent corneal epithelial defect in the right eye and associated exuberant intraocular inflammation as evidenced by a hemorrhagic hypopyon. Despite an extended treatment course with multiple antimicrobial agents, including topical and systemic voriconazole, the patient ultimately underwent penetrating keratoplasty for corneal perforation. Our case represents the first documented instance of PL keratitis in a methamphetamine user, highlighting their increased vulnerability to infectious, including fungal, keratitis. It also demonstrates the challenging and often protracted clinical course of PL keratitis, which often requires both aggressive medical and surgical interventions.