title: Granulomatous inflammation in Acanthamoeba keratitis: an immunohistochemical study of five cases and review of literature.
abstract: OBJECTIVE
  Acanthamoeba keratitis usually presents as a necrotizing stromal inflammation. We report a rare presentation of granulomatous inflammation in Acanthamoeba keratitis
  
  
  METHODS
  Retrospective clinico-pathologic case series.
  
  
  RESULTS
  Five corneal tissues (3 corneal buttons, 2-eviscerated contents) from patients suffering from severe Acanthamoeba keratitis not responding to anti-Acanthamoeba treatment, revealed a florid granulomotous inflammation with multinucleated giant cells in the posterior stroma and around Descemet's membrane. Phagocytosed parasites were noted within the giant cells. Vascularization of the corneal stroma was noted in two cases. Immunophenotyping revealed a predominance of T lymphocytes and macrophages. Clinically, four of five cases had shown features of limbal and scleral involvement.
  
  
  CONCLUSIONS
  Granulomatous inflammation in the posterior corneal stroma, is not an uncommon finding in Acanthamoeba keratitis and could possibly be immune-mediated, contributing to persistence and progression of disease.
  
  
  CONCLUSIONS
  Presence of granulomatous inflammation in Acanthamoeba keratitis, in most cases is associated with limbal and scleral involvement and therefore could be considered as one of the poor prognostic markers. Further studies are required to ascertain the specific clinical features and appropriate management strategies in these cases.
authors.affiliation: Department of Ophthalmic Pathology Service, L V Prasad Eye Institute, L V Prasad Marg, Banjara Hills, Hyderabad- 500 034, India. geeta@lvpei.org
authors.forename: G K
authors.initials: GK
authors.lastname: Vemuganti
authors.forename: G
authors.initials: G
authors.lastname: Pasricha
authors.forename: S
authors.initials: S
authors.lastname: Sharma
authors.forename: P
authors.initials: P
authors.lastname: Garg
mesh_terms: D000048:Acanthamoeba / Q000302:isolation & purification*; D015823:Acanthamoeba Keratitis / Q000503:physiopathology*; D000328:Adult; D000368:Aged; D000818:Animals; D005260:Female; D006099:Granuloma / Q000209:etiology* / Q000469:parasitology; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies