Acanthamoeba Keratitis With Herpes Simplex Keratitis Is a Separate Clinical Entity

Abstract

Abstract: : Purpose.To describe the combination of Acanthamoeba keratitis (AK) and herpes simplex keratitis (HSK) as a separate clinical entity. All cases were diagnosed after a therapeutic penetrating keratoplasty (TPK). Methods: Case 1: A 28–year–old woman with HSK and anterior uveitis developed a corneal ring infiltrate. Corneal culture for acanthamoeba was negative. The prolonged clinical course and failed medical therapy necessitated TPK. Case 2: A 68–year–old man who underwent PK for HSK and acromonium fungal keratitis developed a ring infiltrate in the previously clear graft. Corneal biopsy was performed for acanthamoeba. Case 3: A 16–year–old boy with HSK and stromal keratitis unresponsive to medical treatment underwent a TPK. Confocal microscopy for AK was negative. Results:Clinical presentation is significant for absence of pain, mild conjunctival injection, negative culture and confocal microscopy, and prolonged clinical course. All cases were diagnosed after TPK, with histopathology revealing numerous stromal acanthamoeba cysts. Case 1: 5 years postoperatively there has been no recurrence of AK and the corrected vision is 20/40. Case 2: 6 years postoperatively there has been no recurrence of AK. Case 3: 2 months postoperatively there has been no recurrence of AK. Conclusions:The combination of AK and HSK is a separate clinical entity with atypical presentation and prolonged clinical course that necessitated surgical intervention. Supported by the Richard A. Perritt Charitable Foundation

Keywords: keratitis • cornea: clinical science • Acanthamoeba