Endotheliitis-A Presentation of Acanthamoeba Keratitis

Area of Science:

• Ophthalmology
• Microbiology
• Infectious Diseases

Background:

• Soft contact lens wear is a significant risk factor for microbial keratitis.
• Acanthamoeba keratitis (AK) is a severe infection that can lead to vision loss.
• Early diagnosis of AK is critical for effective treatment and visual recovery.

Observation:

• This study reports four cases of Acanthamoeba keratitis presenting primarily with endotheliitis.
• Patients exhibited pain, red eye, and reduced vision, with localized stromal edema and anterior chamber inflammation.
• Classical signs of AK, such as epithelial defects or stromal infiltrates, were minimal or absent.

Findings:

• Clinical diagnosis of Acanthamoeba endotheliitis was made in all four cases.
• Corneal scrapes were negative for Acanthamoeba, but PCR and confocal microscopy confirmed the diagnosis in two cases.
• Three cases resolved with anti-Acanthamoeba medication alone, showing minimal scarring within seven weeks.

Implications:

• Endotheliitis should be recognized as a potential early indicator of Acanthamoeba keratitis in contact lens wearers.
• A high index of suspicion for Acanthamoeba is necessary, even without typical AK signs.
• Prompt initiation of anti-Acanthamoeba therapy can lead to favorable visual outcomes.