Rare Presentation Of Acanthamoeba And Fungal Keratitis In A Patient

To describe a rare case of combined fungal and parasitic infection in a patient 

30 yr old male presented with h/o noticing a corneal infiltrate .was treated locally  with topical steroids as a dignosis of viral keratitis was made . the condition progressed and after 1 month patient presented to our out patient clinic .how we went about managing the case based on microbiological examination will be discussed .

the patient had a full-thickness corneal infiltrate which was extending limbus to limbus .corneal scraping  was done which showed fungal elements as well as acanthamoeba cysts .this was a rare occurence.there was no scleral involvement. as the ulcer was long standing with involvement upto limbus we decided to perform a therapeutic keratoplasty in the patient to reduce the infection load.the donor button was sent for culture .intracemeral wash was done with voriconazole .a large therapeutic graft was done ensuring complete removal of all infected cornea 

post therapeutic keratoplasty the infection load had been removed and the graft clarity was grade 4. there was minimal fibrin reaction.patient was symptomatically better with lesser pain .was started on a combination of antifungal and antiparasitic treatment and responded well with no recurrence .he is awaiting a optical keratoplasty 

many a time corneal infiltrates are misdiagnosed in peripheral hospitals due to poor access to microbiology testing .as a result they are treated with steroids which in turn flares up the existing condition.Mixed infections are common where bacterial and fungal elements are seen but this was rare as we had fungal elements and acanthamoeba cysts on scraping.the decision to perform a therapeutic keratoplasty was made as the condition at presentation was advanced with involvement extending upto the limbus . a combination of antifungal and antiparasitic treatment was given in the post operative period .The aim of treating infectious keratitis is to help salvage the globe and prevent spread of infection into the posterior segment of the eye.