Concurrent Microsporidial and HSV Keratitis in an Immunocompetent Child

Purpose: The most common misdiagnosis of microsporidial stromal keratitis is HSV keratitis. We describe the successful diagnosis and resolution of a case of stromal keratitis which was PCR positive for both microsporidia and HSV in an immunocompetent patient. Observations: Clinically suspected to be stromal microsporidial keratitis, the corneal scrapings were positive for both microsporidia as well as HSV-1. Polyhexamethylene biguanide (PHMB) 0.04%, voriconazole 1%, ganciclovir 0.15% topically combined with oral albendazole were employed to obtain a favorable outcome. Conclusions: Unresponsive cases of microsporidial keratitis should also be evaluated for HSV, especially given the ubiquitous nature of the latter.