Mistaken identity: the mysterious case of a corneal ulcer

A 36-year-old contact lens wearer presented to hospital with symptoms typically associated with acanthamoeba keratitis


US clinicians have described their treatment of a 36-year-old patient who presented to hospital with a corneal ulcer.

Describing the case in BMJ Case Reports, the authors highlight that the corneal ulcer in the patient’s right eye had persisted for the past month, despite using topical fluoroquinolone therapy.

The patient, who was a soft contact lens wearer, had a ring-shaped infiltrate typically seen in acanthamoeba infections.

After the patient’s condition deteriorated, a penetrating keratoplasty was performed.

Post-operative analysis suggested a diagnosis of herpes simplex viral (HSV) keratitis. The patient’s condition improved following treatment with anti-viral medication.

The authors highlighted: “Clinical diagnosis of atypical HSV keratitis can often be challenging. The case was diagnosed initially as acanthamoeba keratitis considering the clinical presentation: ring-shaped infiltrate, severe pain and photophobia and a history of contact lens wear.”

They emphasised that clinical presentation alone is not a reliable basis for diagnosing infectious keratitis. 

Photo credit: BMJ Case Reports