Microsporidial stromal keratitis: an uncommon etiology of bilateral simultaneous corneal infection

  • Pragnya R. Donthineni, Dr. Cornea Service, L.V. Prasad Eye Institute, Hyderbad
  • Somasheila I. Murthy Cornea Service, L.V. Prasad Eye Institute, Hyderbad
  • Joveeta Joseph Jhaveri Microbiology Centre L V Prasad Eye Institute
  • Prashant Garg Director, Kallam Anji Reddy Campus, L V Prasad Eye Insititute
  • Manisha Acharya Cornea And Refractive Surgery Dept Dr Shroff’s Charity Eye Hospital
  • Virender Sangwan Director, Innovations, Dr Shroff’s Charity Eye Hospital
DOI: https://doi.org/10.35119/asjoo.v17i3.720
Keywords: bilateral corneal infection, indolent keratitis, microsporidia outcomes, microsporidial stromal keratitis, therapeutic keratoplasty

Abstract

We report three cases of bilateral microsporidial keratitis, which is an unusual presentation. All three patients presented with bilateral, simultaneous, asymmetrical, deep stromal corneal infiltrates with symptoms ranging from 5 to 12 months. Predisposing factors were noted in two of three patients. Corneal scrapings for microbiology and histopathology of corneal tissue revealed microsporidial spores from both eyes of all patients. There was no response to medical therapy and all underwent bilateral corneal transplantation. Case one additionally had recurrences in the graft and underwent repeat keratoplasties and eventually keratoprosthesis. Microsporidial stromal keratitis is a possible cause of keratitis in cases of very long-standing, indolent, culture-negative, deep stromal corneal infiltrates. So far, this infection has been reported as unilateral; however, we report these cases of bilateral infection, which is rare. Corneal transplantation is the preferred line of management due to lack of response to medical therapy.

References

Metcalfe TW, Doran RM, Rowlands PL, Currey A, Lacey CJ. Microsporidial keratoconjunctivitis in a patient with AIDS. Br J Ophthalmol. 1992; 76:177–178.

Sabhapandit S, Murthy SI, Garg P, Korwar V, Vemuganti GK, Sharma S. Microsporidial Stromal Keratitis: Clinical Features, Unique Diagnostic Criteria, and Treatment Outcomes in a Large Case Series. Cornea. 2016;35(12):1569-1574

Yoken J, Forbes B, Maguire AM, Prenner JL, Carpentieri D. Microsporidial endophthalmitis in a patient with acute myelogenous leukemia. Retina. 2002;22(1):123-125.

On Annie LH, Ray M. Bilateral simultaneous infective keratitis. Cont Lens Anterior Eye. 2017;40(4):224-227.

Tzamalis A, Romano V, Cheeseman R, Vinciguerra R, Batterbury M, Willoughby C. Bandage contact lens and topical steroids are risk factors for the development of microbial keratitis after epithelium-off CXL. BMJ Open Ophthalmol. 2019;16;4(1)

Vemuganti GK, Garg P, Sharma S, Joseph J, Gopinathan U, Singh S. Is microsporidial keratitis an emerging cause of stromal keratitis? A case series study. BMC Ophthalmol. 2005;5:19

Joseph J, Sridhar MS, Murthy S, Sharma S. Clinical and microbiological profile of microsporidial keratoconjunctivitis in southern India. Ophthalmology. 2006;113:531–537.

Sood AB, Debiec MR, Yeh S, Grossniklaus HE, Randleman JB. Microsporidial stromal keratitis and endophthalmitis in an immunocompetent patient. J Ophthalmic Inflamm Infect. 2016;6(1):30

Mathis A, Weber R, Deplazes P. Zoonotic potential of the microsporidia. Clin Microbiol Rev. 2005;18(3):423-45

Coca M, Kim J, Shenoy S, Chévez-Barrios P, Kapur M. Microsporidial Stromal Keratitis: Successful Treatment with Topical Voriconazole and Oral Itraconazole. Cureus. 2016 20;8(12):934.

Published
2020-12-31
How to Cite
Donthineni, P., Murthy, S., Joseph, J., Garg, P., Acharya, M., & Sangwan, V. (2020). Microsporidial stromal keratitis: an uncommon etiology of bilateral simultaneous corneal infection. Asian Journal of Ophthalmology, 17(3), 311-317. https://doi.org/10.35119/asjoo.v17i3.720
Issue
Vol 17 No 3 (2020): Asian Journal of Ophthalmology
Section
Case Reports/Case Series

Copyright (c) 2020 Pragnya R. Donthineni, Dr., Somasheila I. Murthy, Joveeta Joseph, Prashant Garg, Manisha Acharya, Virender Sangwan

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