Pediatric microsporidial keratitis following fingernail trauma: A rare case report in a 45-day-old infant

We report a rare case of presumed microsporidial keratitis in a 45-day-old male infant following a self-inflicted fingernail injury to the right eye. The child presented with a white corneal dot persisting for 15 days. Initial empirical therapy with topical antibiotics and antifungals showed no clinical improvement, with worsening noted by day 3. Examination under anesthesia and corneal scraping were performed on day 4. Microbiology revealed structures resembling Microsporidia spp. Due to its extreme rarity in infants, a teleconsultation was sought, which suggested a Gram-positive cocci-like clinical picture. A revised treatment regimen – including fortified vancomycin, moxifloxacin, voriconazole eye drops, and albendazole syrup – was initiated. While no immediate improvement was observed, the condition stabilized by day 6 and showed marked improvement by day 8. Complete recovery occurred by day 45. This case illustrates the diagnostic challenges, therapeutic decisions, and utility of teleconsultation in managing rare ocular infections in pediatric patients.