Acanthamoeba Keratitis With Granulomatous Reaction Involving the Stroma and Anterior Chamber

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Abstract
Most cases of granulomatous reaction to Descemet membrane are caused by disciform herpes simplex and mycotic keratitis. To our knowledge, a clinicopathologic report ofAcanthamoebaspecies infection has not been documented. We used standard histopathologic techniques, including light microscopy with special stains and indirect immunofluorescence. A granulomatous reaction with many multinucleated giant cells, some of which engulfed cysts ofAcanthamoebaspecies, was present in the posterior corneal stroma and anterior chamber along the plane of Descemet membrane. A severe, acute, suppurative inflammatory response and areas of stromal necrosis also were present. The diagnosis ofAcanthamoeba castellaniiwas confirmed by immunofluorescent studies. A granulomatous reaction to Descemet membrane and/or the corneal stroma may represent a specific tissue response to various infectious agents. Keratitis caused byAcanthamoebaspecies may be added to herpes simplex stromal keratitis and mycotic keratitis as a causative organism capable of producing a granulomatous reaction involving the stroma and anterior chamber.