A Case of Acanthamoeba–Cladosporium Coinfection Keratitis in a Contact Lens Wearer Without Ocular Trauma

ABSTRACT: We report the first case of confirmed Acanthamoeba-Cladosporium coinfection keratitis in a soft contact lens (CL) wearer without any history of ocular trauma, and to highlight its diagnostic and therapeutic implications. A healthy 23-year-old woman with a 10-year history of daily-disposable soft CL wear and no ocular trauma presented with 3 days of acute ocular pain and conjunctival injection in the right eye. Slit-lamp examination revealed a 2.0×2.0-mm paracentral corneal infiltrate with an irregular margin, mild corneal oedema, and an anterior chamber reaction. Corneal scraping with Gram staining demonstrated typical Acanthamoeba cysts, and Sabouraud dextrose agar culture with lactophenol cotton blue mounting confirmed Cladosporium species. Empirical topical voriconazole 2% was initiated at the first visit together with anti-amoebic therapy. Complete resolution was achieved with improvement of visual acuity at the 3-month follow-up. Acanthamoeba-Cladosporium coinfection can occur in CL wearers even in the absence of ocular trauma. Because Cladosporium keratitis is characteristically indolent and both organisms share environmental niches, coinfection should be actively investigated in any atypical CL-related keratitis. Early empirical voriconazole, which covers both Cladosporium and Acanthamoeba, may be pivotal in achieving medical cure of this rare and potentially sight-threatening entity.