Recalcitrant beauveria bassiana keratitis - Confocal Microscopy findings and treatment with posaconazole (Noxafil)

Purpose: To report the clinical, confocal microscopic, and histologic appearance of a case of Beauveria bassiana keratitis and response to medical therapy. Methods: A 58-year-old woman with a 1-month history of a recalcitrant contact tens-related corneal ulcer was evaluated by confocal microscopy and corneal scraping for histology and culture. Results: Confocal microscopy and histology revealed a filamentous fungal keratitis continued by culture as B. bassiana resistant to amphotericin B. The keratitis was unresponsive to multiple topical and systemic antiftingals but resolved after the addition of oral posaconazole. Conclusions: B. bassiana is a rare cause of keratitis that may show significant resistance to topical and systemic antifungals but was treated successfully with the addition of oral posaconazole to topical voriconazole. Confocal microscopy and corneal smears may be of benefit in identifying and directing therapy for this slow-growing fungus.