Escleroqueratitis por Acanthamoeba:  reporte de dos casos clínicos

Jordan Nicolás Maresca

doi:10.70313/2718.7446.v18.n4.464

Authors

Jordan Nicolás Maresca Centro Oftalmológico de Diagnóstico.

DOI:

https://doi.org/10.70313/2718.7446.v18.n4.464

Keywords:

scleritis, acanthamoeba, keratitis, sclerokeratitis, contact lens, abscess

Abstract

Objective: To present two cases of Acanthamoeba keratitis associated with scleritis —an uncommon but severe manifestation— highlighting diagnostic challenges, therapeutic considerations, and their unfavorable clinical outcomes.

Case reports: We describe two adult patients with Acanthamoeba keratitis who progressed to nodular and subsequently necrotizing scleritis. Both received intensive anti-amoebic therapy (PHMB 0.02% + chlorhexidine 0.02%) and systemic immunosuppression due to scleral inflammation. Despite multidisciplinary management, both cases evolved poorly: the first patient developed corneal perforation and phthisis bulbi, requiring evisceration; the second patient experienced corneal perforation secondary to immune-mediated limbal failure, requiring urgent penetrating keratoplasty, and later died from systemic complications associated with immunosuppressive therapy.

Conclusion: The coexistence of Acanthamoeba keratitis and scleritis represents a severe and challenging entity with high risk of ocular loss and systemic complications. These cases underscore the importance of early diagnosis, aggressive treatment, and close follow-up, as well as prompt recognition of scleral involvement to optimize visual and systemic outcomes.

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