Acanthamoeba keratitis with granulomatous reaction involving the stroma and anterior chamber

Most cases of granulomatous reaction to Descemet membrane are caused by disciform herpes simplex and mycotic keratitis. To our knowledge, a clinicopathologic report of Acanthamoeba species infection has not been documented. We used standard histopathologic techniques, including light microscopy with special stains and indirect immunofluorescence. A granulomatous reaction with many multinucleated giant cells, some of which engulfed cysts of Acanthamoeba species, was present in the posterior corneal stroma and anterior chamber along the plane of Descemet membrane. A severe, acute, suppurative inflammatory response and areas of stromal necrosis also were present. The diagnosis of Acanthamoeba castellanii was confirmed by immunofluorescent studies. A granulomatous reaction to Descemet membrane and/or the corneal stroma may represent a specific tissue response to various infectious agents. Keratitis caused by Acanthamoeba species may be added to herpes simplex stromal keratitis and mycotic keratitis as a causative organism capable of producing a granulomatous reaction involving the stroma and anterior chamber.