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Case report demonstrates effective multi-route posaconazole management in an agricultural worker with endophthalmitis.
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
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Xu et al. (2026) studied this question.
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