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Resolution of microsporidial epithelial keratopathy in a patient with AIDS
R W Yee1, F O Tio, J A Martinez
1Department of Ophthalmology, University of Texas Health Science Center, San Antonio 78284.
Abstract:
A patient with a positive human immunodeficiency virus (HIV) titer and cryptococcal meningitis suffered bilateral epithelial keratopathy caused by Encephalitozoon, which did not respond to sulfas, erythromycin, bacitracin, tobramycin, neomycin, polymyxin B, or fluconazole. Eventual administration of itraconazole for the meningitis apparently produced resolution of the long-lasting (2-month) ocular infection. This new oral triazole antifungal may be valuable against the increasingly prevalent microsporidial infections in patients with acquired immune deficiency syndrome. Debulking of the infection by corneal scraping may have contributed to the authors' success.
Insights
A patient with HIV and cryptococcal meningitis experienced an ocular infection due to Encephalitozoon. Itraconazole successfully treated the infection, suggesting its value for microsporidial infections in AIDS patients.
Area of Science:
- Ophthalmology
- Infectious Diseases
- Mycology
Background:
- Human immunodeficiency virus (HIV) infection predisposes individuals to opportunistic infections.
- Cryptococcal meningitis is a serious complication in advanced HIV disease.
- Ocular microsporidiosis, caused by Encephalitozoon, presents a diagnostic and therapeutic challenge in immunocompromised patients.
Observation:
- A patient with HIV and cryptococcal meningitis developed bilateral epithelial keratopathy.
- The ocular infection was unresponsive to multiple conventional antimicrobial and antifungal agents, including fluconazole.
- Symptoms persisted for two months despite various treatments.
Findings:
- Administration of itraconazole, an oral triazole antifungal, led to the resolution of the Encephalitozoon-induced keratopathy.
- Corneal scraping (debulking) may have also contributed to the successful treatment outcome.
- This case highlights itraconazole as a potential therapeutic option for microsporidial eye infections.
Implications:
- Itraconazole shows promise for treating microsporidial infections, particularly in patients with acquired immune deficiency syndrome (AIDS).
- Early diagnosis and prompt treatment are crucial for managing opportunistic infections in immunocompromised individuals.
- Further research is warranted to establish the efficacy and optimal use of itraconazole in ocular microsporidiosis.