2010 OMIG, Abstract 8

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Acanthamoebal and Stenotrophomonas maltophilia keratitis with fungal keratitis in the contralateral eye
W.I. Sawyer, R.A. Kuennen, R. Harder-Smith, T.F. Mauger
Havener Eye Institute, The Ohio State University, Columbus, OH

Purpose: To describe the diagnosis, course, and outcome of a case of Acanthamoeba and Stenotrophomonas keratitis with a concominant case of fungal keratitis in the contralateral eye.
Methods: Medical records, confocal microscopy, microbiologic and histopathologic specimens were reviewed. Isolate identification and susceptibility testing were performed by the Ohio State University Medical Center microbiology laboratory.
Results: A rigid gas permeable contact lens wearer who washed his contacts and case with tap water on a regular basis presented with multiple stromal infiltrates in the left cornea. Vision in the right eye was 20/20 and in the left was 20/80. The patient was a physician and had self treated with tobradex before seeking ophthalmologic consultation. Confocal microscopy showed multiple cysts consistent with Acanthamoeba. Corneal cultures of the left cornea were negative. Left contact lens case cultures grew Acanthameoba as well as Stenotrophomonas maltophilia. The patient was treated aggresively with neosporin, brolene, polyhexamethylene biguanide (PHMB) 0.02%, clotrimazole 1%, and atropine in the left eye. Two weeks later the patient developed pain and photophobia in the right eye. Stromal infiltrates were observed. Confocal microscopy did not demonstrate any cysts but did show evidence of hyphae in the right cornea. Cultures of the right cornea and right contact lens case were negative. Therapy was then changed to treat both eyes with natamycin, neosporin, brolene, polyhexamethylene biguanide (PHMB) 0.02%, and clotrimazole 1%. Both eyes underwent complete resolution of infiltrates and return of visual acuity to 20/20.
Conclusions: This case emphasizes the importance of evaluating both corneas independently when there are similar clinical presentations bilaterally.Confocal microscopy has been shown to be a reliable method of detecting Acanthamoeba and fungal elements in infected corneas. The possibility exists that one or both of the corneas could have had combined Acanthamoeba and fungal keratitis.

Disclosure Code: N