Acanthamoeba keratitis - Importance the Early Diagnosis

This is a case report of Acanthamoeba as a causative agent of keratitis at the Department of Ophthalmology, University Hospital Rijeka. Delay in treatment led to an advanced stage of the disease with multiple complications. Initially, presented symptoms were similar to those of herpetic keratitis. In the mean time progression of the disease led to a cloudy cornea with a stromal ring infiltrate, poor vision, elevated intraocular pressure, a mature cataract and finally corneal melt. Corneal scrapings were obtained from a 28 years old female patient, wearing soft contact lenses and with poor lens hygiene. Acanthamoeba cysts were identified by the cytological examination. Culture of the corneal scraping had confirmed Acanthamoeba as the etiological agent. Making the diagnosis of Acanthamoeba is difficult. We presented this case of delayed diagnosis and unfavorable outcome as a reminder that clinical suspicion remains the most important diagnostic tool. Contact lens wears with a new diagnosis of herpes simplex keratitis are in high risk group, especially those with significant pain or poor response to conventional therapy. We also wanted to point out the possibility of an early, prompt and inexpensive diagnosis with the cytological examination.