Tracing Acanthamoeba In A Third-Trimester Pregnant Woman With Keratitis

To describe Acanthamoeba keratitis (AK) in a 31-week pregnant woman who wore therapeutic soft contact lenses and to emphasize the value of in vivo confocal microscopy (IVCM) for diagnosis.

Department of Ophthalmology, Ege University Faculty of Medicine, Department of Ophthalmology, Mugla Sitki Kocman University Faculty of Medicine, Department of Parasitology, Tokat Gaziosmanpasa University Faculty of Medicine

A 33-year-old pregnant woman at 31 gestational weeks presented with decreased vision, photophobia, pain, and redness in her right eye. A soft therapeutic contact lens had been placed 10 days earlier due to a recurrent epithelial defect. Her best-corrected visual acuity (BCVA) was 0.05. Biomicroscopic examination revealed conjunctival hyperaemia, an irregular corneal epithelium, mild stromal oedema, and opacities suggestive of perineural infiltrates. Because the patient reported pain that was disproportionate to her clinical findings and had a history of contact lens use, AK was suspected. Giemsa-stained corneal scrapings revealed Acanthamoeba spp. cysts. IVCM scans showed giant trophozoites with a highly reflective, speckled pattern and polygonal-shaped cysts surrounded by a low-reflectivity halo. Chlorhexidine 0.02% was used as an anti-ameobal agent. Punctal pressure was applied for 3 minutes after administering the drops to reduce systemic absorption. Clinical follow-up demonstrated improvement, and the dose was gradually reduced. After three months of maintenance therapy, she recovered without complications with a final BCVA of 1.0.

To the best of our knowledge, this is the third reported case of AK during pregnancy. Although there were no risky behaviors associated with contact lens use, physiological changes on the ocular surface during pregnancy might have increased susceptibility. Additionally, it is important to note that IVCM is a quick and accurate tool for early diagnosis of AK.