Paecilomyces lilacinus is a rare cause of contact lens-associated keratitis. The infection is difficult to eradicate because of multiple antifungal drug resistance and has a poor outcome. A female patient developed contact lens-associated keratitis and Paecilomyces lilacinus could be demonstrated in the corneal abrasion. Despite antifungal therapy with voriconazole a keratoplasty à chaud was necessary and a poor final visual acuity could not be avoided.