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Case Report

JCDR. 2014; 5(4): 67-69


Prosthetic valve infection caused by Paecilomyces lilacinus

Amarjeet Kaur, Smita Sarma, Sunil Sharma, Yatin Mehta.


Abstract

Paecilomyces lilacinus is an environmental mold, which is found worldwide in soil and on decomposing vegetation. It
is emerging as an important fungal pathogen reported from various parts of the world like Europe, America, Middle east
etc. Though very rarely pathogenic in humans, there are, however few case reports of pulmonary infections, sinusitis,
abdominal wall abscess, ocular infections, dermatologic infections and deep soft tissue abscess. We report the first case
of Paecilomyces lilacinus prosthetic valve infection in an immunocompetent patient. He came with the complaints of
chest pain, breathlessness and pain in left groin. Echocardiography revealed bioprosthetic aortic valve with dehiscence.
Carotid doppler showed bilateral intimal thickening and peripheral doppler revealed embolism in left saphenofemoral
artery. Patient underwent redo aortic valve replacement and left femoral embolectomy. His aortic tissue and femoral
embolus was sent to the microbiology lab. Direct microscopy using potassium hydroxide showed hyaline septate fungal
hyphae and culture grew Paecilomyces lilacinus after 2 weeks. The isolate was found to be susceptible to amphotericin B
(MIC 0.125 μg/ml), caspofungin (MIC 0.125 μg/ml), posaconazole (MIC 0.125 μg/ml) and voriconazole (MIC 0.006 μg/
ml). Though this species is more resistant to antifungal drugs but our isolate was sensitive and patient was successfully
treated with amphotericin B and voriconazole.

Key words: Paecilomyces lilacinus, Prosthetic valve.






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