Bilateral microsporidial keratoconjunctivitis in an immunocompetent non-contact lens wearer.
OBJECTIVE
To describe an immunocompetent male with bilateral microsporidial keratoconjunctivitis who responded to treatment with albendazole, propamidine, and fumagillin.


METHODS
Corneal and conjunctival epithelial scrapings from a man with bilateral keratoconjunctivitis previously treated with topical corticosteroids were evaluated by Gram stain and by fluorescence microscopy.


RESULTS
Gram stain and fluorescence microscopy of corneal epithelial scraping revealed organisms characteristic of microsporidia. Results of human immunodeficiency virus antibody testing were reported as nonreactive. Symptoms of ocular discomfort and clinical signs of keratoconjunctivitis resolved after five weeks of treatment that included systemic albendazole and topical propamidine isethionate 0.1% and fumagillin bicyclohexylammonium salt. A follow-up conjunctival scraping failed to detect any residual organisms 2 weeks after cessation of all treatment.


CONCLUSIONS
Microsporidial ocular infection occurred in an immunocompetent non-contact lens wearer. Microsporidial keratoconjunctivitis should be considered in any individual with atypical multifocal diffuse epithelial keratitis, regardless of immune status or recent history of contact lens wear.
Lewis
Noni L
NL
Department of Opthalmology, The Prince of Wales Hospital, University of New South Wales, Randwick, Sydney. nonilewis@infolearn.com.au
Francis
Ian C
IC
Hawkins
Glenn S
GS
Coroneo
Minas T
MT
D000328:Adult; D015766:Albendazole / Q000627:therapeutic use; D000818:Animals; D000981:Antiprotozoal Agents / Q000627:therapeutic use; D001550:Benzamidines / Q000627:therapeutic use; D003261:Contact Lenses; D003510:Cyclohexanes; D005231:Fatty Acids, Unsaturated / Q000627:therapeutic use; D006801:Humans; D007121:Immunocompetence; D007637:Keratoconjunctivitis / Q000276:immunology* / Q000469:parasitology* / Q000473:pathology; D008297:Male; D016816:Microsporida / Q000302:isolation & purification; D016881:Microsporidiosis / Q000188:drug therapy / Q000469:parasitology; D012717:Sesquiterpenes; D016896:Treatment Outcome
D000981:Antiprotozoal Agents; D001550:Benzamidines; D003510:Cyclohexanes; D005231:Fatty Acids, Unsaturated; D012717:Sesquiterpenes; C026211:fumagillin; D015766:Albendazole; C005555:propamidine