Abstract

Pythium and Acanthamoeba are rare agents causing keratitis. Their fulminant nature and relentless progression, warrants the need for vigilance and prompt diagnosis. Coinfection with both, to our knowledge, has only been reported once, and offers a tremendous challenge to diagnosis and management. A young healthy female presented with a month-long history of diminished vision in the right eye following carrom powder fall. Her visual acuity was 6/36. On examination she had an active stromal infiltrate with tentacular margins and limbal encroachment. Corneal scraping showed acanthamoeba cysts in Gram stain with positive culture on non-nutrient agar. KOH stain showed fungal hyphae. Diffuse cloudy growth on blood agar was tested for zoospore formation and Pythium was confirmed. She was started on hourly PHMB 0.02% and TPK was done. Post-operatively she was treated with azithromycin and PHMB eye drops. With one episode of graft rejection at 18 months follow up, patient maintains clear graft.