Acanthamoeba keratitis is a serious infection that can lead to loss of vision. It is highly challenging and often poses a diagnostic dilemma, causing delay in diagnosis and treatment. We report herewith the clinical and histopathology findings of a patient with an atypical presentation of acanthamoeba keratitis in Bahrain. The patient is a 16-year-old Bahraini teenager who was a cosmetic contact lens wearer. She presented with clinical signs and symptoms of microbial keratitis, which was initially misdiagnosed elsewhere as a case of herpetic corneal infection. Her corneal biopsy confirmed the clinical diagnosis as acanthamoeba keratitis. The patient was started on anti amoebic treatment. The infection got eradicated. The cornea healed with a central scar. Eventually, she underwent penetrating keratoplasty. This case report serves to raise awareness of this rare condition. Clinicians should have a high index of suspicion when diagnosing such cases among contact lens wearers. Early diagnosis and treatment are crucial to prevent serious complications.
References
[1]
Marciano-Cabral, F. and Cabral, G. (2003) Acanthamoeba spp. as Agents of Disease in Humans. Clinical Microbiology Reviews, 16, 273-307. https://doi.org/10.1128/CMR.16.2.273-307.2003
[2]
Radford, C.F., Minassian, D.C. and Dart, J.K. (2002) Acanthamoeba Keratitis in England and Wales Incidence, Outcome, and Risk Factors. British Journal of Ophthalmology, 86, 536-542. https://doi.org/10.1136/bjo.86.5.536
[3]
Lorenzo-Morales, J., Khan, N.A. and Walochnik, J. (2015) An Update on Acanthamoeba Keratitis: Diagnosis, Pathogenesis and Treatment. Parasite, 22, 1-20 https://doi.org/10.1051/parasite/2015010
[4]
Seal, D.V. (2003) Acanthamoeba Keratitis Update Incidence, Molecular Epidemiology and New Drugs for Treatment. Eye, 17, 893-905. https://doi.org/10.1038/sj.eye.6700563
[5]
Chynn, E.W., Lopez, M.A, Pavan-Langston, D. and Talamo, J.H. (1995) Contact Lens and Non Contact Lens Characteristics. Ophthalmology, 102, 1369-1373. https://doi.org/10.1016/S0161-6420(95)30862-7
[6]
Krachmer, J. Mannis, M. and Holland, E. (2010) Cornea: 3rd Edition. Elsevier, Amsterdam.
[7]
Moore, M.B. and McCulley, J.P. (1989) Acanthamoeba Keratitis Associated with Contact Lenses: Six Consecutive Cases of Successful Management. British Journal of Ophthalmology, 73, 271-275. https://doi.org/10.1136/bjo.73.4.271
[8]
Masselam, K. and Pineda, R. (2008) Topical Voriconazole as an Effective Co-Agent against Acanthamoeba Keratitis. Investigative Ophthalmology & Visual Science, 49, 5537
[9]
Hou, T., Chen, Y. and Hsu, C. (2017) Rapid Resolution of Stromal Keratitis with the Assistance of Oral Voriconazole in Resistant Acanthamoeba Keratitis. Taiwan Journal of Ophthalmolgy, 7, 224-226. https://doi.org/10.4103/tjo.tjo_73_17
[10]
Bacon, A.S., Frazer, D.G., Dart, J.K., Matheson, M., Ficker, L.A. and Wright, P. (1993) A Review of 72 Consecutive Cases of Acanthamoeba Keratitis, 1984-1992. Eye, 7, 719-725. https://doi.org/10.1038/eye.1993.168
[11]
Kitzmann, A.S., Goins, K.M., Sutphin, J.E. and Wagoner, M.D. (2009) Keratoplasty for Treatment of Acanthamoeba Keratitis. Ophthalmology, 116, 864-869. https://doi.org/10.1016/j.ophtha.2008.12.029
[12]
Perry, H.D., Donnenfeld, E.D., Foulks, G.N., Moadel, K. and Kanellopoulos, A.J. (1995) Decreased Corneal Sensation as an Initial Feature of Acanthamoeba Keratitis. Ophthalmology, 102, 1565-1568. https://doi.org/10.1016/S0161-6420(95)30830-5
[13]
Laerhout, I., Goegebuer, A., Van Den, B.C. and Kestelyn, P. (2004) Delay in Diagnosis and Outcome of Acanthamoeba Keratitis. Graefe’s Archive for Clinical and Experimental Ophthalmology, 242, 648-653. https://doi.org/10.1007/s00417-003-0805-7
[14]
Stan, C., Cristina, V. and Mihael, P. (2016) Acanthamoeba Keratitis Challenges a Case Report. Romanian Journal of Ophthalmology, 60, 40-42.
[15]
Szentmary, N., Daas, L., Shi, L., Laurik, K.L., Milioti, G., Seitz, B., et al. (2019) Acanthamoeba Keratitis—Clinical Signs, Differential Diagnosis and Treatment. Journal of Current Ophthalmology, 31, 16-23. https://doi.org/10.1016/j.joco.2018.09.008
[16]
Agab, A., Albuainain, A. and Al Bin Ali, G. (2017) Unilateral Acanthamoeba Keratitis Following the Use of Cosmetic Contact Lens. Bahrain Medical Bulletin, 39, 69-71. https://doi.org/10.12816/0047447
[17]
Drancourt, M. and Hoffart, L. (2017) Infectious Diseases. 4th Edition, Elsevier Ltd., Amsterdam.
[18]
Dini, L.A., Cockinos, C., Frean, C., Niszi, I.A. and Markus, M.B. (2000) Unusual Case of Acanthamoeba polyphaga and Pseudomonas aeruginosa Keratitis in a Contact Lens Wearer. Journal of Clinical Microbiology, 38, 826-829. https://doi.org/10.1128/JCM.38.2.826-829.2000
