[Bilateral microsporidial keratitis in an HIV-positive patient with AIDS stage infection].

BACKGROUND

Microsporidia are spore-forming, obligate intracellular protozoa. Humans seem to be infected only by 4 genera of microsporidia. Microsporidial keratoconjunctivitis in immunodeficient patients has a characteristic appearance.

METHODS

34 year old woman with AIDS complained of bilateral blurred vision. The visual acuity was 0.6 on both eyes. She had a mild conjunctivitis and disseminate, not very prominent intraepithelial corneal opacities. She was treated with propamidine isethionate 0.1% 5 times daily and artificial tears under presumptive diagnosis of microsporidial keratoconjunctivitis. We discontinued this treatment because of no improvement. Within 6 months the visual acuity decreased to 0.05. A conjunctival smear was positive for microsporidia. Local Fumagillin-eye-drops 0.07 mg/ml 7 times daily were given. Within 2 weeks an impressively improvement was seen. Because of an persisting diarrhea 400 mg Albendazol twice daily was added orally without success.

CONCLUSIONS

The biomicroscopically changes of microsporidial keratoconjunctivitis are characteristical and lead to the clinical diagnosis. Fumagillin is in vitro and clinically a potent antimicrosporidian agent with an extremely broad therapeutic range.