title: Microsporidial Stromal Keratitis: Successful Treatment with Topical Voriconazole and Oral Itraconazole.
abstract: We report a case of microsporidial stromal keratitis successfully treated with topical voriconazole and oral itraconazole. A 30-year-old Hispanic male construction worker who wears contacts lenses presented with left eye erythematous, epiphora, and mild pain increasing over few days after failing previous antibiotics treatment. His best corrected visual acuity in the left eye was count fingers at three feet, and the slit lamp examination showed 3+ conjunctival injection, a circular central corneal ulcer 3.2 mm in diameter, stromal thinning, and an anterior chamber with white cells, flair, and 0.1 mm hypopyon. A cornea punch biopsy identified microsporidial organisms with some features suggestive of Vittaforma corneae. After treatment with topical voriconazole and oral itraconazole for eight weeks, the patient had complete resolution with no recurrence for over 12 months of follow-up. To our knowledge, this is the first reported case of successful treatment of microsporidial stromal keratitis with antifungals.
authors.affiliation: Chicagoland Retinal Consultants ; Ophthalmology, UTMB.
authors.forename: Mircea
authors.initials: M
authors.lastname: Coca
authors.affiliation: Ophthalmology, Froedtert Eye Institute, Medical College of Wisconsin, Milwaukee, WI.
authors.forename: James
authors.initials: J
authors.lastname: Kim
authors.affiliation: Texas Tech University Health Sciences Center.
authors.forename: Sudhir
authors.initials: S
authors.lastname: Shenoy
authors.affiliation: Department of Pathology and Genomic Medicine, Department of Ophthalmology, Houston Methodist Hospital, Houston, TX.
authors.forename: Patricia
authors.initials: P
authors.lastname: Chévez-Barrios
authors.affiliation: Coastal Eye Associates.
authors.forename: Manuj
authors.initials: M
authors.lastname: Kapur
keywords: cornea; itraconazole; medical treatment; microsporidium; stromal keratitis; voriconazole