Acanthamoeba keratitis, while an uncommon form of keratitis, is important to recognize and treat aggressively. Unfortunately, due to its encysted form, acanthamoeba is not only difficult to diagnose with standards methods of culture, but it is also very resistant to treatment. Our patient presented with atypical keratitis, initially diagnosed with herpetic keratitis but required reassessment with failure of typical antiviral treatment. After a prolonged course of multiple repeat cultures and biopsy, she was diagnosed with Acanthamoeba keratitis. Due to the poor response to topical treatment, the patient was started on miltefosine PO. She had rapid worsening of keratitis after miltefosine therapy, suggesting the possibility of worsening infection or an inflammatory process. She underwent repeat biopsy without growth of Acanthamoeba. Due to a negative biopsy, her clinical decline was deemed due to inflammation likely caused from the break down products of Acanthamoeba, resembling a “Jarisch-Herxheimer” type reaction. Though anti-inflammatory therapy remains controversial in the literature, our patient did well with aggressive topical steroid therapy.
Presentation Date: 05/28/2020
Issue Date: 08/01/2020