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In Vivo Confocal Microscopy Evaluation of Microbial Keratitis

Educational Objective
Based on this clinical scenario and the accompanying image, understand how to arrive at a correct diagnosis.
1 Credit CME

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Article Information

Corresponding Author: Matias Soifer, MD, Department of Ophthalmology, Duke Eye Center, Duke University, 2351 Erwin Rd, Durham, NC 27710 (matias.soifer@duke.edu).

Published Online: August 26, 2021. doi:10.1001/jamaophthalmol.2021.0948

Conflict of Interest Disclosures: None reported.

Additional Contributions: We thank Cristiaan Lopez-Miro, CPT, ophthalmic photographer, Duke Eye Center, and the patient for granting permission to publish this information.

References
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Yuan  X , Wilhelmus  KR , Matoba  AY , Alexandrakis  G , Miller  D , Huang  AJW .  Pathogenesis and outcome of Paecilomyces keratitis.   Am J Ophthalmol. 2009;147(4):691-696.e3. doi:10.1016/j.ajo.2008.11.016PubMedGoogle ScholarCrossref
2.
Ali  TK , Amescua  G , Miller  D ,  et al.  Contact-lens-associated purpureocillium keratitis: risk factors, microbiologic characteristics, clinical course, and outcomes.   Semin Ophthalmol. 2017;32(2):157-162. doi:10.3109/08820538.2015.1011342PubMedGoogle ScholarCrossref
3.
Chew  R , Dorman  A , Woods  ML .  Purpureocillium lilacinum keratitis: a case series and review of the literature.   Can J Ophthalmol. 2016;51(5):382-385. doi:10.1016/j.jcjo.2016.05.013PubMedGoogle ScholarCrossref
4.
Turner  LD , Conrad  D .  Retrospective case-series of Paecilomyces lilacinus ocular mycoses in Queensland, Australia.   BMC Res Notes. 2015;8:627. doi:10.1186/s13104-015-1591-0PubMedGoogle ScholarCrossref
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Almeida Oliveira  M , Carmo  A , Rosa  A , Murta  J .  Posaconazole in the treatment of refractory Purpureocillium lilacinum (former Paecilomyces lilacinus) keratitis: the salvation when nothing works.   BMJ Case Rep. 2019;12(4):e228645. doi:10.1136/bcr-2018-228645PubMedGoogle Scholar
6.
Kanavi  MR , Javadi  M , Yazdani  S , Mirdehghanm  S .  Sensitivity and specificity of confocal scan in the diagnosis of infectious keratitis.   Cornea. 2007;26(7):782-786. doi:10.1097/ICO.0b013e318064582dPubMedGoogle ScholarCrossref
7.
Kheirkhah  A , Syed  ZA , Satitpitakul  V ,  et al.  Sensitivity and specificity of laser-scanning in vivo confocal microscopy for filamentous fungal keratitis: role of observer experience.   Am J Ophthalmol. 2017;179:81-89. doi:10.1016/j.ajo.2017.04.011PubMedGoogle ScholarCrossref
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