Slowly progressive corneal opacification in a patient with known mucocutaneous Leishmaniasis and HIV

Authors


Abstract

Purpose To present a case of corneal opacification and anterior uveitis in a patient with systemic Leishmaniasis

Methods Case report

Results A 40-year old HIV-positive patient was already followed for conjunctival involvement in systemic Leishmaniasis. Treatment with Glucantime was effective, but had to be stopped because of acute pancreatitis. A switch to Ambisome was made, but did not result in complete resolution. Slow appearance of corneal stromal opacities was also noted at this time. In January 2011 the patient consulted in emergency and was diagnosed with bilateral acute anterior uveitis as well as manifest progression of the stromal opacification. Regarding the inflammation, a good initial response was obtained with topical prednisolone acetate. However, a slumbering reaction remained present in the anterior chamber and an increase of the keratic precipitates was noted. On tapering of the steroids, several relapses occurred. The intrastromal opacities were still increasing, resulting in worsening visual acuity. An in-vivo confocal microscopy of the cornea was performed and showed presence of cystic structures in the stroma, possibly related to intracorneal presence of the parasite. Because of insufficient response of the anterior chamber reaction to topical steroids, anterior chamber tap was performed and PCR showed positive for Leishmania. A tentative treatment with intrastromal and intracameral injection of Amphotericin B was initiated.

Conclusion We report an atypical ocular presentation of Leishmaniasis, with proven presence of the organism in the aqueous humor, and presence of the cystic structures on in-vivo confocal microscopy. A tentative treatment with intrastromal and intracameral injection of Amphotericin B was initiated.

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