ACANTHAMOEBA KERATITIS COMPLICATED WITH HERPETIC ENDOTHELITIS

To present a case of acanthamoeba keratitis complicated with herpetic endothelitis.

Department of Ophthalmology, Cornea Department, General Hospital of Athens, Korgialenio-Benakio Hellenic Red Cross, Athens, Greece

A 29-year-old female patient was referred to our clinic with a history of keratitis of her right eye (RE) caused by contact lens wear. Her initial clinical presentation was decreased visual acuity (VA) and corneal epithelial defect, with focal stromal infiltrates. She was treated with topical drops of second generation quinolone, without any improvement. A sample of corneal epithelium was sent for positive and negative gram stain, as well as for PCR test for herpes simplex virus and acanthamoeba, but no pathogen was isolated. In vivo confocal microscopy showed acanthamoeba cysts at 84μm of corneal depth. 12 days after therapy with “Acanthamoeba keratitis management protocol” and significant improvement of VA, a new deterioration of VA and signs of herpetic endothelitis were recorded. She was prescribed systemic antivirals and topical drops of dexamethasone.

3 months later, her RE shows no signs of active inflammation and best corrected visual acuity (BCVA) is 1.0. Herpetic endothelitis may coexist as a secondary infection in case of acanthamoeba keratitis.

Topical steroids are a controversial issue in acanthamoeba keratitis treatment. However, in our case, they don’t seem to affect the clinical course of the disease. Review of literature on co-existing acanthamoeba keratitis and herpetic endothelitis shows that cases are rare.