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This abstract is assigned to session AOB Poster session 2 - Inflammatory pathology – Anterior segment – Ophthalmogenetics - Miscellaneous

Title	Posterior segment complications following Acanthamoeba keratitis
Abstract Nr.	2023

Purpose	Emphasize the severity of posterior segment complications after acanthamoeba keratitis.
Methods	Follow-up of a patient with Acanthamoeba keratitis.
Results	A 36 year old male contact lens wearer presented with bilateral Acanthamoeba keratitis confirmed in the left eye by positive culture and PCR. After initiation of treatment with polyhexamethylene biguanide and propamidine drops, the keratitis right resolved fairly quickly but the keratitis in the left eye evolved with eventually the development of a painful anterior nodular scleritis. Besides the addition of topical steroids , oral steroids and eventually the use of oral azathioprine were needed to relief the pain. Despite prophylactic use of oral itraconazole, the sclerokeratitis evolved into a panuveitis with concomittant retinitis and papillary edema. Enucleation of the left eye was necessary because of severe pain and to prevent extra-ocular spread. Pathology confirmed the presence of acanthamoeba cysts in the sclera, retina and vitreous. Because of anemia, thoracic imaging was performed which showed multiple lung nodules. Biopsy of those nodules showed hyphae, compatible with Aspergillosis pneumonia.
Conclusion	Scleritis, is a dreaded complication of Acanthamoeba keratitis, associated with a poor prognosis and a high rate of enucleation. Literature suggests immunosuppressive treatment to improve symptoms and to reduce the enucleation rate. This case study however indicates that systemic immunosuppressive treatment, even under prophylaxis of an antifungal agent, should always be used with greatest caution.
Conflict of interest	No

Authors 1

Last name	KEMELS
Initials	D
Department	University Hospitals Leuven
City	Leuven

Authors 2

Last name	HUA
Initials	M
Department	University Hospitals Leuven
City	Leuven

Authors 3

Last name	DELBEKE
Initials	H
Department	University Hospitals Leuven
City	Leuven

Authors 4

Last name	VAN GINDERDEUREN
Initials	R
Department	University Hospitals Leuven
City	Leuven

Authors 5

Last name	FOETS
Initials	B
Department	University Hospitals Leuven
City	Leuven