[Delayed course of Acanthamoeba keratitis].

Area of Science:

• Ophthalmology
• Infectious Diseases
• Microbiology

Background:

• Corneal ulceration can be challenging to diagnose, particularly when symptoms overlap with other conditions.
• Herpes simplex keratitis is a common cause of corneal ulcers, often treated with antiviral therapy.
• Contact lens wear is a significant risk factor for microbial keratitis, including Acanthamoeba keratitis.

Observation:

• A 35-year-old male presented with severe ulcerative stromal keratitis, hypopyon, and hyphemia, with a history of prolonged antiviral treatment for suspected herpetic keratitis.
• Despite initial treatment for herpes simplex keratitis, the patient's condition worsened, prompting a re-evaluation.
• The patient had a history of long-term contact lens wear, a key risk factor for Acanthamoeba keratitis.

Findings:

• The diagnosis was revised to Acanthamoeba keratitis based on clinical presentation and risk factors.
• Surgical interventions, including penetrating excimer laser keratoplasty with cryotherapy and later with an amniotic membrane patch, were performed.
• Aggressive topical antimicrobial and anti-inflammatory therapy was administered.

Implications:

• Acanthamoeba keratitis should be considered in the differential diagnosis of microbial keratitis, especially in contact lens wearers, even with initial signs suggestive of herpes simplex keratitis.
• Prompt and accurate diagnosis is essential to initiate appropriate treatment and prevent vision loss.
• This case highlights the importance of considering less common pathogens in persistent or atypical presentations of keratitis.