A case of stromal microsporidiosis: medical strategies employed for successful resolution.

Anita Raghavan, Devi Rosette Raja, Narendran Venkatapathy, Ram Rammohan

BMJ case reports 2022 Feb 14

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We describe the diagnosis and successful management of a case of stromal microsporidiosis, an important emerging ocular disease. Stromal microsporidiosis is recalcitrant and very often requires therapeutic keratoplasty for effective eradication. We successfully managed a steroid-treated case diagnosed only after 9 months, with a combination of polyhexamethyl biguanide 0.04%, chlorhexidine 0.04% and fluconazole 0.3% eye drops supplemented with tablet albendazole. However, complete resolution was achieved only after epithelial debridement. Toxicity due to the drugs was not noted. Diagnostic delays, steroid use and inappropriate therapy are commonly observed in stromal microsporidiosis. In spite of these potential disadvantages, our case responded well with complete eradication of the infection. The disease being fairly indolent and slowly progressive, medical therapy should be continued, in the absence of progression or other complications. Epithelial debridement may facilitate healing. © BMJ Publishing Group Limited 2022. No commercial re-use. See rights and permissions. Published by BMJ.

Citation

Anita Raghavan, Devi Rosette Raja, Narendran Venkatapathy, Ram Rammohan. A case of stromal microsporidiosis: medical strategies employed for successful resolution. BMJ case reports. 2022 Feb 14;15(2)