Importance of clinical signs leading to the diagnosis in a case of microbiological smear negative ocular microsporidiosis

Session Details

Session Title: Presented Poster Session: Spotlight on Cornea

Venue: Poster Village: Pod 2

First Author: : P.Agarwal UAE

Co Author(s): :    S. Navon                       

Abstract Details

Purpose:

This case highlights importance of clinical signs in determining the diagnosis, when lab investigations and microbiological smears are negative. The clinical signs are of paramount importance in the absence of a definitive microbiological diagnosis which dictates the initial treatment, thereby preventing morbidity and subsequent visual loss because of delayed treatment.

Setting:

Cleveland clinic Abu Dhabi

Methods:

28-year-old patient presented with pain watering redness and blurred vision in the left eye, with a best corrected visual acuity of 20/40 There was no relevant history of contact with contaminated water or contact lens usage.   Patient was treated elsewhere prior to presentation with topical moxifloxacin eye drops 4 times a day and topical steroids for 2 weeks without any resolution. She discontinued all the treatment 2 days prior to presentation. Examination revealed multifocal coarse raised epithelial lesions with epithelial defect . smear was stained with grams stain for microsporidial spores and the other with 10% KOH for fungal hyphae.

Results:

Gram stain was negative for bacteria and microsporidial spores. 10%, KOH was negative for fungal hyphae. Based on strong clinical signs of corneal microsporidiosis, in spite of the negative microbiology smear the patient was started on voriconazole eye drops 5 times a day. The epithelial defect healed and the lesions started fading with mild sub epithelial haze  and completely healed with resolution of sub epithelial haze Corneal epithelium and stroma remained clear on follow-up of 2 months with  uncorrected visual acuity of 20/20. No relevant history pertaining to exposure of contaminated water, swimming or history of trauma could be elicited.

Conclusions:

This is an unusual case with smear negative report which highlights importance of clinical signs in clinching the diagnosis, when lab investigations and microbiological smears are negative. The clinical diagnosis is of paramount importance in the absence of definitive microbiological diagnosis. The clinical signs help in formulating the initial treatment, thereby preventing morbidity. Delayed treatment with on-going inflammation cause epithelial and subepthelial scarring and subsequent visual loss and the need for cornea transplant surgeries.

Financial Disclosure:

None