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Concurrent Acanthamoeba and Fusarium Keratitis With Silicone Hydrogel Contact Lens Use

Purpose: To report a case of simultaneous Acanthamoeba and Fusarium keratitis associated with no-rub multipurpose contact lens solution and silicone hydrogel contact lens use. Method: Observational case report. Results: A 39-year-old woman was referred for worsening of a presumed bacterial corneal ulcer in the setting of silicone hydrogel lens wear with occasional overnight wear, no-rub multipurpose contact lens solution use, and combined topical antibiotic/corticosteroid treatment. Initial corneal scrapings and culture confirmed Acanthamoeba and Fusarium solani, corroborated by in vivo confocal microscopy findings, yet despite topical chlorhexidine 0.02%, propamidine 1%, neomycin/polymyxin B ointment, and natamycin 5% along with oral itraconazole, the ulcer worsened. Four days after amoebic and fungal therapy initiation, it was discovered that the pharmacy accidentally dispensed neomycin/polymyxin B/dexamethasone, and despite immediate discontinuation, therapeutic penetrating keratoplasty from corneal melting was ultimately required. Corneal histopathology confirmed the presence of amoebic cysts and fungal elements. Conclusions: Coexisting infection with Acanthamoeba and Fusarium species can occur in contact lens wear. Atypical infection must be considered in patients with corneal ulcers demonstrating poor therapeutic response in the setting of contact lens wear. Corticosteroids should be used with extreme caution in contact lens-related corneal infections, especially when the diagnosis remains unknown because they can lead to acceleration of active infection and keratolysis.