Voriconazole-resistant Purpureocillium lilacinum endophthalmitis in an agricultural worker: A case report.

Purpureocillium lilacinum is an emerging opportunistic pathogen with a distinct ocular tropism, most commonly causing keratitis. We report a case of refractory endophthalmitis in an agricultural worker caused by a voriconazole-resistant strain of P. lilacinum with a detailed genomic sequence. After failure of initial voriconazole therapy, the patient was successfully managed with surgical intervention and a novel, multi-route posaconazole regimen, comprising systemic (intravenous and oral), topical, and intravitreal administration. This case underscores the emergence of voriconazole resistance in P. lilacinum endophthalmitis and demonstrates the successful use of a comprehensive posaconazole-based therapeutic strategy.