|Year : 2022 | Volume
| Issue : 1 | Page : 255-256
Acanthamoeba sclerokeratitis: Infection or inflammation?
Himabindu Alluri, Tanvi Soni, Sujata Das
Cornea Services, LV Prasad Eye Institute, Bhubaneswar, Odisha, India
|Date of Submission||26-May-2021|
|Date of Acceptance||01-Jul-2021|
|Date of Web Publication||07-Jan-2022|
Dr. Sujata Das
L V Prasad Eye Institute, Bhubaneswar, Odisha - 751 024
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Alluri H, Soni T, Das S. Acanthamoeba sclerokeratitis: Infection or inflammation?. Indian J Ophthalmol Case Rep 2022;2:255-6
Acanthamoeba sclerokeratitis (ASK) is a rare complication of Acanthamoeba keratitis. We describe the clinical features and management of ASK that presented with infectious nodular scleritis.
A 92-year-old male complained of redness, irritation, and watering following the fall of an insect in the right eye since 2 months; there was no history of any other systemic illness. On examination, his best-corrected visual acuity in the right eye was perception of light. Slit-lamp examination revealed edematous lids, conjunctival hyperemia, 7 × 8 mm epithelial defect, stromal edema, faint grayish infiltrate of size 4 × 5 mm in the center of the cornea, and hypopyon [Figure 1]a, and a normal B-scan ultrasonography. Microbiological examination of corneal scraping revealed double-walled hexagonal cysts suggestive of Acanthamoeba cysts on potassium hydroxide with calcofluor white staining [Figure 1]b. The patient was started on topical polyhexamethylene biguanide (0.02%) eye drops hourly and chlorhexidine (0.02%) eye drops hourly. However, the patient was not compliant with medications, and he presented with increased pain after 1 week. Examination revealed persistent epithelial defect with an increase in stromal infiltrate size and contiguous nodular scleral lesion with an active pus point at 7 O'clock position [Figure 1]c.
|Figure 1: (a) Slit-lamp photo under diffuse illumination showing conjunctival hyperemia, central epithelial defect, and faint grayish stromal infiltrate with hypopyon in the right eye during the first visit; (b) microscopy showing double-walled Acanthamoeba cysts on KOH calcofluor staining from smear taken from sclera nodule; (c) slit-lamp photo under diffuse illumination showing persistent epithelial defect with stromal infiltrate and scleral nodule at 7 O' clock position|
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Scleral exploration revealed Acanthamoeba cysts on smear examination along with growth on non-nutrient agar with Escherichia coli overlay. He was continued with anti-Acanthamoeba treatment (AAT) and systemic itraconazole (100 mg) twice daily. The patient could not come for follow-up due to nationwide lockdown imposed to curb COVID-19 (coronavirus disease 2019).
| Discussion|| |
The pathogenesis of ASK is poorly understood. The underlying process can be either inflammation due to persistence of antigen of Acanthamoeba or active infection that can be established only by the absence or presence of viable cysts, respectively. The reported incidence of ASK is 6% to 18% and the most commonly reported cases are diffuse scleritis with inflammatory etiology., There have been isolated reports of four cases of infectious nodular ASK with poor clinical outcomes and of these two underwent enucleation.,, We described a case of nodular ASK with viable cysts in sclera, and AAT was continued. The authors suggest that nodular scleral lesion contiguous with keratitis should prompt to rule out active infection. The treatment for ASK is largely guided by a well-defined stepladder approach for diffuse scleritis. The approach to treatment in nodular ASK is affected by a dearth of evidence due to rare occurrences.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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