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.