title: Polymicrobial and microsporidial keratitis in a patient using Boston scleral contact lens for Sjogren's syndrome and ocular cicatricial pemphigoid.
abstract: OBJECTIVE
  To report a rare case of microsporidial and polymicrobial keratitis in a patient with Sjogren's syndrome and ocular cicatricial pemphigoid.
  
  
  METHODS
  This is a descriptive case report. A 66-year-old lady diagnosed with Sjogren's syndrome (SS) and ocular cicatricial pemphigoid (OCP) presented to us with microbial keratitis after using a Boston sclera contact lens for a painful epithelial defect. After 9 days of medical treatment, she underwent therapeutic penetrating keratoplasty.
  
  
  RESULTS
  10% potassium hydroxide and calcofluor white wet mount revealed microsporidial spores. Gram positive cocci and Gram variable bacilli on Gram stain were identified as Staphylococcus epidermidis and Corynebacterium accolens in culture. Histopathological examination of the corneal tissue confirmed the presence of microsporidial spores.
  
  
  CONCLUSIONS
  Microsporidal keratitis can occur in patients with severe ocular surface disease due to SS and OCP. Predisposing factors include dry eye, local and systemic immunosuppression and Boston scleral contact lens. Early surgical intervention may be needed to eradicate the infection.
authors.affiliation: Cornea and Anterior Segment Service, LV Prasad Eye Institute, Visakhapatnam, India. merle@lvpei.org
authors.forename: Merle
authors.initials: M
authors.lastname: Fernandes
authors.forename: Savitri
authors.initials: S
authors.lastname: Sharma
mesh_terms: D000368:Aged; D003261:Contact Lenses / Q000009:adverse effects* / Q000382:microbiology; D003315:Cornea / Q000382:microbiology / Q000473:pathology*; D015818:Eye Infections, Bacterial / Q000209:etiology* / Q000382:microbiology; D015821:Eye Infections, Fungal / Q000209:etiology* / Q000382:microbiology; D005260:Female; D006801:Humans; D007634:Keratitis / Q000209:etiology* / Q000382:microbiology; D016814:Microsporidia / Q000302:isolation & purification; D016881:Microsporidiosis / Q000209:etiology* / Q000382:microbiology; D010390:Pemphigoid, Benign Mucous Membrane / Q000150:complications* / Q000628:therapy; D012590:Sclera / Q000601:surgery; D012859:Sjogren's Syndrome / Q000150:complications* / Q000628:therapy; D014792:Visual Acuity