Microsporidial stromal keratitis and endophthalmitis in an immunocompetent patient

Abstract

Purpose: The purpose of this study is to report a case of microsporidial endophthalmitis after penetrating keratoplasty in a healthy patient and discuss the management.

Methods: This is a case report.

Results: A 69-year-old healthy male underwent penetrating keratoplasty for corneal scar secondary to herpes stromal keratitis. He presented with features of acute graft rejection 3 years later. After failure of medical management, a repeat full thickness keratoplasty was performed. Pathologic examination of the corneal specimen showed microsporidia. The patient then developed a chronic endophthalmitis, and a vitreous tap and injection followed by pars plana vitrectomy were performed. Pathologic examination of tissue showed microsporidia.

Conclusions: Microsporidia are being increasingly identified as the cause of stromal keratitis. This is the first report of microsporidial endophthalmitis in a patient without underlying systemic illness.

Fig. 1

External photograph of left eye. The corneal sutures are intact. There is a yellow opacity overlying the pupil

Fig. 2

The superficial stroma showing organisms measuring 2 μm × 4 μm

Fig. 3

Intrastromal organisms without polarization (left) and with polarization (middle) and staining with AFB (right)

Fig. 4

Transmission electron microscopy showing a 2 μm × 4 μm organism that contains an anchoring disk exospore, endospore, polaroplast, polar filament coils, nucleus, and ribosomes