CLINICAL CASE: A MULTIDIAGNOSTIC APPROACH FOR DIAGNOSIS OF CENTRAL CORNEAL LESION

To describe the utility of an integrated, multi-modal diagnostic approach (cytology, SEM, IF, and culture) in successfully identifying and managing a complex ocular co-infection refractory to initial conventional testing.

A 43-year-old woman presented with acute keratitis after soft contact lens use, characterized by severe pain, photophobia, and central corneal opacification. Due to clinical complexity and non-response to initial empiric treatment, a comprehensive diagnostic approach was required.

Diagnostic management included multiple techniques: optical cytology, Scanning Electron Microscopy (SEM), Direct Immunofluorescence (IF) for HSV-I and Chlamydia, and ocular microbiological swab (culture). The findings were used to guide a targeted, multi-drug therapeutic regimen. Follow-up was conducted for three months.

Diagnostic integration was crucial, as the initial culture swab was negative. SEM and IF confirmed a rare and aggressive co-infection involving Acanthamoeba, Candida, HSV type I, and Chlamydia. The targeted treatment led to a significant reduction in the lesion and pain within one month, resulting in complete resolution of infectious and inflammatory phenomena after three months.

This case highlights the critical need for an integrated, multi-factorial diagnostic approach in complex anterior segment diseases, especially when overlapping infectious and inflammatory conditions are suspected. Reliance solely on culture results may lead to missed diagnoses and ineffective management.