Paecilomyces species are a rare cause of fungal pulmonary infections in immunocompromised hosts. Paecilomyces variotii and Paecilomyces lilacinus are the two most common species of clinical significance. Both species differ in their susceptibility to antifungal agents. We present a rare case of a 47-year-old immunocompromised woman who developed Paecilomyces pneumonia despite being on voriconazole prophylaxis. We also present a review of the literature on other reported cases.
Learning points:

Paecilomyces species differ in their susceptibility to antifungal agents.Breakthrough invasive mould infections are increasingly being documented in immunocompromised patients on voriconazole prophylaxis.Posaconazole has been shown to be effective against both Paecilomyces species.