Topical fumagillin in the treatment of microsporidial keratoconjunctivitis in AIDS.
OBJECTIVE
To report microsporidial keratoconjunctivitis in a patient infected with HIV who was treated with topical fumagillin.


METHODS
A 37-year-old white man who was experiencing redness, pain, irritation, decreased vision, and a foreign body sensation occurring in both eyes was referred to the ophthalmology clinic. The patient had a medical history significant for AIDS, Pneumocystis carinii pneumonia, and Cytomegalovirus retinitis. Conjunctival smears were taken and stained positive for the presence of Microsporidia. The patient was diagnosed with bilateral microsporidial keratoconjunctivitis and fumagillin therapy was initiated. After 5 days of therapy, the patient reported significant improvements characterized by a decrease in blurred vision with only slight blurring in the left eye, decrease in headache, and decreased foreign body sensation. The patient continued topical fumagillin therapy for more than 14 months, with only slight blurring in the left eye and no apparent ocular toxicity as a result of fumagillin therapy.


CONCLUSIONS
Although rare in occurrence, increasing numbers of documented microsporidial infections are being reported in the medical literature, particularly in individuals who are seropositive for HIV. Clinicians need to be cognizant of microsporidial keratoconjunctivitis as another opportunistic infection in this patient population.


CONCLUSIONS
Although a curative agent has yet to be discovered, fumagillin represents a safe, effective, low-cost, topical agent for the treatment of microsporidial keratoconjunctivitis.
University of California, Davis Medical Center, Sacramento 95817, USA.
M J
MJ
Garvey
P G
PG
Ambrose
J L
JL
Ulmer
D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy* / Q000469:parasitology; D000287:Administration, Topical; D000328:Adult; D000818:Animals; D000981:Antiprotozoal Agents / Q000009:adverse effects / Q000627:therapeutic use*; D003510:Cyclohexanes; D016819:Encephalitozoon; D016890:Encephalitozoonosis / Q000188:drug therapy* / Q000469:parasitology; D005231:Fatty Acids, Unsaturated / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D007639:Keratoconjunctivitis, Infectious / Q000188:drug therapy* / Q000469:parasitology; D008297:Male; D012717:Sesquiterpenes
D000981:Antiprotozoal Agents; D003510:Cyclohexanes; D005231:Fatty Acids, Unsaturated; D012717:Sesquiterpenes; C026211:fumagillin