Acanthamoeba keratitis with granulomatous reaction involving the stroma and anterior chamber
H. Mietz and R. L. Font
Department of Ophthalmology, Cullen Eye Institute, Baylor College of Medicine, Houston, Tex., USA.
Most cases of granulomatous reaction to Descemet membrane are caused by
disciform herpes simplex and mycotic keratitis. To our knowledge, a
clinicopathologic report of Acanthamoeba species infection has not been
documented. We used standard histopathologic techniques, including light
microscopy with special stains and indirect immunofluorescence. A
granulomatous reaction with many multinucleated giant cells, some of which
engulfed cysts of Acanthamoeba species, was present in the posterior
corneal stroma and anterior chamber along the plane of Descemet membrane. A
severe, acute, suppurative inflammatory response and areas of stromal
necrosis also were present. The diagnosis of Acanthamoeba castellanii was
confirmed by immunofluorescent studies. A granulomatous reaction to
Descemet membrane and/or the corneal stroma may represent a specific tissue
response to various infectious agents. Keratitis caused by Acanthamoeba
species may be added to herpes simplex stromal keratitis and mycotic
keratitis as a causative organism capable of producing a granulomatous
reaction involving the stroma and anterior chamber.
