A case of microsporidial keratitis in an HIV-positive patient: Clinical and diagnostic insights

Microsporidia are small, oval, obligate intracellular eukaryotic protozoan parasites that mostly cause infections in immunocompromised individuals. The ocular manifestations include superficial punctate keratoconjunctivitis and corneal stromal keratitis. We report a case of microsporidial keratitis in an HIV patient (>500 cells/mm 3 ) successfully treated with topical voriconazole and systemic albendazole. A 50-year-old male presented with redness, watering, and pain in his left eye 1 month after failing a previous antibiotic steroid combination treatment. His best corrected visual acuity in the left eye was finger counting at 4 m and on slit lamp examination he had conjunctival congestion with a central circular corneal ulcer of about 3 mm in diameter with stromal infiltrates and anterior chamber hypopyon of about 1 mm. Microsporidial organisms were identified on corneal scraping and successfully treated for 8 weeks. The patient had complete resolution with the formation of leucomatous corneal opacity.